Closed angle glaucoma and myopia as an adverse effect of topiramate

Purpose To present a case report of a patient under topiramate treatment for a depression syndrome, with bilateral acute and closed angle glaucoma as drug adverse effects Methods Thirty-seven-year-old male developed bilateral severe blurred vision. Exploration showed bilateral acute myopia and closed anterior chambers. Intraocular pressures were 48 mmHg in both eyes, with shallow anterior chambers, and closed angles. His refraction was -6.25 diopters in right eye, and -8,50 in left eye. During ophthalmic exploration he developed eye pain and corneal edema. Results All symptoms and clinical findings, including myopia and pain, resolved completely upon discontinuation of topiramate and administration of antiglaucoma drugs. Conclusion Topiramate may cause acute bilateral angle-closure glaucoma , so blurry vision, eye pain or altered image perception in treated subjects should be carefully explored by an ophthalmologist. Acute angle closure may result in important intraocular pressure elevation and irreversible optic nerve damage, causing permanent visual loss; so treatment must be withdrawn immediately when alarm symptoms appear.