Brief report
Mechanism of topiramate-induced acute-onset myopia and angle closure glaucoma

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Abstract

Design

Interventional case report.

Methods

In an institutional practice setting, two women, aged 25 and 45, developed acute myopia after starting topiramate for epilepsy. One patient also developed bilateral angle closure glaucoma.

Results

Topiramate was discontinued. Anterior chamber shallowing was noted in both patients at presentation. Ultrasonography showed ciliochoroidal effusion. Baseline measurements of anterior chamber depth and lens thickness were obtained.

Conclusions

Topiramate may be associated with ciliochoroidal effusion with forward displacement of the lens-iris diaphragm and anterior chamber shallowing, resulting in acute myopia and angle-closure glaucoma. Increased lens thickness contributes only minimally (9%–16%) to anterior chamber shallowing.

Section snippets

Case 1

A 25-year-old woman with epilepsy and depression presented with a 2-day history of severely blurred vision. Medications were lamotrigine (200 mg twice daily, 18 months), venlafaxine (37.5 mg twice daily, 12 months), and topiramate (50 mg twice daily, 7 days, starting at 50 mg daily). Examination revealed visual acuity of 1/60 bilaterally, mild conjunctival chemosis, severe anterior chamber shallowing, closed angles on gonioscopy, and elevated intraocular pressure (IOP; 40 mm Hg right, and 39 mm

Case 2

A 45-year-old woman with epilepsy presented with sudden onset of bilateral blurred distance vision and improved discrimination of fine detail at near. Medications were frusemide (40 mg twice daily, 5 years), phenobarbitone (30 mg twice daily, 5 years), carbamazepine (400 mg twice daily, 3 years), lamotrigine (200 mg twice daily, 12 months), and topiramate (25 mg twice daily, 10 days, starting at 25 mg daily). Visual acuity was 6/36 bilaterally improving to 6/4 with myopic correction (previously

References (5)

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