Título

ANGLE CLOSURE AND ACUTE MYOPIA FOLLOWING TOPIRAMATE USE: REPORT OF TWO CASES

Objetivo

To report 2 cases of angle closure, ocular hypertension and acute myopia following topiramate use for migraine. Pathophisiology of this condition is reviewed and ocular findings are documented by Ultrabiomicroscopy and anterior segment OCT. Treatment options for this condition are discussed.

Relato do Caso

We present 2 cases of acute angle closure glaucoma and acute myopia following topiramate use in adult female patients. Typically that adverse effect occurs at a young age. Both cases presented similar ocular findings: appositional angle closure and severe ocular hypertension in both eyes, as well as lens-iris-diaphragm marked anterior displacement. The 17-year-old patient presented to the emergency room with acute onset painless blurred vision and severe myopic shift. The second case is a 31-year-old who reported excruciating headache, ocular pain and acute loss of vision. Due the severity of her pain, she was hospitalized and further general investigation showed unremarkable findings. Topiramate was immediately discontinued and they were managed with topical and oral anti-glaucoma medications, topical steroids and cycloplegics. The IOP decreased significantly and the myopic shift showed reversal in both cases. Furthermore they underwent careful scrutiny of ocular findings, which documented the morphologic changes in the anterior eye segment.

Conclusão

Topiramate is a widely prescribed drug in a number of conditions. Bilateral acute myopia and angle closure glaucoma are side effects of this drug. It is imperative to discard that etiology especially in patients younger than 50-years-old who appear with sudden onset blurry vision and bilateral ocular pain. The treatment for that condition differs from the treatment of primary angle closure glaucoma, as miotics and laser iridotomy are contraindicated. OCT and UBM are valuable tools to help differentiate those conditions.