Careful examination of the lens revealed glaucomflecken. Palomares P, Amselem L, Diaz-Llopis M Optical coherence tomography for diagnosis and monitoring of, 51. [42] underwent LPI before establishing a diagnosis of TiAAC as the patient was initially thought to have acute angle closure. Both had secondary AAC and high intraocular pressure, after discontinuing topiramate. Sympathomimetic drugs (e.g., phenylephrine, pseudoephedrine) and parasympatholytic drugs (e.g., atropine, ipratropium) dilate the pupil and thus pose a risk of angle closure through this mechanism. Rhee DJ, Goldberg MJ, Parrish RK Bilateral, 61. You may search for similar articles that contain these same keywords or you may A 29-year-old woman presented with bilateral blurry vision and headache. During an acute attack, patients typically present with marked elevation of intraocular pressure (IOP), corneal edema, ocular pain, headache, blurred vision, and perception of halos around lights. Indian J Ophthalmol. The glaucomatous and angle closure mechanism occurring from Topamax use is not relative pupil block, but seems to be a sulfa-allergic response with resultant swelling and congestion, as well as effusion, detachment or forward rotation of the ciliary body.21-24 Topiramate-induced ciliochoroidal effusion with forward displacement of the lens-iris . [1] Following its widespread use, several systemic adverse effects were documented following treatment with TPM, such as weight loss,[2] cognitive dysfunction,[3] and kidney stones. The first case is a 48 year old female referred by an outside ophthalmologist for acute vision loss and elevated intraocular pressure. Bovino JA, Marcus DF The mechanism of transient myopia induced by sulfonamide therapy Am J Ophthalmol 1982 94 99 102, 7. Around half of cases (51.9%) were treated with a systemic CAI to provide a further reduction in IOP, whereas CAIs were avoided in the remaining cases to prevent the occurrence of an idiosyncratic reaction that may lead to progression of the ciliochoroidal effusion and subsequently a paradoxically increased IOP. The patient was instructed to stop taking topiramate and to follow-up with his primary care doctor regarding alternative treatment for his systemic medical problems. The presence of such information would have provided more insight into the mechanisms underlying TiAAC. Figure 5. Pilocarpine was stopped and the patient was also told to discontinue his topiramate. Interventional case report. Santos-Nevarez V, Cantrell J, Gruosso P, Miller J, Culotta-Glynn T, 68. Cialis Together 10mg Tablets - Tadalafil - 4 Tablets. A great proportion of reported patients with TiAAC were females (75.3%); however, this does not necessarily imply that females are at a higher risk of TiAAC. In this article, we conducted a systematic review of these case reports in an attempt to summarize the current body of evidence on clinical features, management options, and prognosis of TiAAC. Viet Tran H, Ravinet E, Schnyder C, Reichhart M, Guex-Crosier Y, Guex-Crosier Y Blood-brain barrier disruption associated with, 81. The Ophthalmic Side Effects of Topiramate: A Review. Glaucoma represents a heterogeneous group of chronically progressive neurodegenerative bilateral diseases of the optic nerve, clinically characterized by optical neuropathy, resulting in retinal ganglion cell death, optic nerve head cupping, and associated specific loss of the visual field [ 1, 2, 3 ]. Prakash J, Prabhu HRA, Srivastava K, Bhat PS, Kumar RS Acute myopia and secondary angle closure, 54. If the condition is not promptly recognized, sustained elevated intraocular pressure may lead to permanent damage to the optic nerve. Her family history was significant for cataracts and retinal detachment, but no glaucoma. Box 400 Al-Ahsa - 31982, Saudi Arabia. FOIA It has been reported to occur in three per 100,000 patients taking the medication [5]. "In these patients, the drug should be stopped, or patients can lose their vision," he says. The .gov means its official. Our second patient presented with evidence pointing towards both acute angle closure glaucoma and topiramate induced secondary angle closure glaucoma. Gonioscopic examination showed appositional angle closure for 360 in both eyes. 5 Fraunfelder FW et al. van Issum C, Mavrakanas N, Schutz JS, Shaarawy T. Topiramate-induced acute bilateral angle closure and myopia: pathophysiology and treatment controversies. But skin creams and inhalers are also worrisome. Fundus examination of both eyes was unremarkable, with healthy optic discs. It is thought to be a result of the forward movement of the lens-iris diaphragm. eCollection 2022. When faced with an unusual presentation of bilateral angle closure glaucoma, with a history of topiramate use being elicited on history, it is reasonable to initially treat the patient with bilateral LPIs and then topical corticosteroids and cycloplegics. 5A represents normal ocular anatomy. 1 It's also used off-label to treat a wide range of mood and eating disorders and to aid in substance abuse therapy. Pilocarpine, a topical cholinergic, is used as a miotic in the treatment of angle closure due to pupillary block. Figure 2. Cycloplegia relaxes the cilary body and tighten the zonules, keeping the iris-lens diaphragm in check. Topamax (topiramate) is an anticonvulsant medication used to treat epilepsy and migraine headaches. Topiramate-induced acute bilateral angle closure and myopia: pathophysiology and treatment controversies. Helps you get and maintain an erection when you need it. The patient was discharged with topical combination of dorzolamide 2%/timolol maleate 0.5% BID, latanoprost 0.005% once daily, brimonidine tartrate 0.15% BID, atropine 1% TID, and prednisolone acetate 1% QID for both eyes. In addition, ciliary body swelling decreases zonular tension, which increases lens thickness. Lan YW, Hsieh JW Bilateral acute angle closure, 38. Over the next week, the patients vision returned to 20/20 in each eye. 1992;85(8):499-500. These findings suggest that this patient might have had pre-existing angle closure before developing TiAAC. Save 2.20. Topiramate-associated acute, bilateral, secondary angle-closure glaucoma. official website and that any information you provide is encrypted Our search through online databases yielded 537 citations. From an ophthalmologic perspective, TiAAC should be ruled out in any patient presenting with acute angle closure by inquiring about their drug history. The brand-name medication that topiramate oral tablets are based on is called Topamax . Communication regarding the adverse event will aid in alternative management of the patients nonophthalmic condition(s). Pathak-Ray V, Chandran P Acetazolamide-associated idiosyncratic simultaneous bilateral angle closure and cross-sensitivity Am J Ther 2020 27 e680 2. These effects are believed to be the result of an idiosyncratic drug reaction, which responds to prompt cessation of the drug.5. The authors speculate that the advancement of a subclinical angle closure could be the causal mechanism behind this delayed presentation. Department of Ophthalmology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, USA. The use of CAIs was controversial between studies. Lens-iris diaphragm displacement. Medications may be safe for one type of glaucoma but risky for another. Delayed topiramate-induced bilateral angle-closure glaucoma. These drugs are implicated in supraciliary effusions due to an idiosyncratic drug reaction. In addition, pilocarpine can cause anterior displacement of the lens-iris diaphragm through rounding of the lens secondary to contraction of the ciliary muscles. This article describes a case of topiramate induced acute transient myopia. Unauthorized use of these marks is strictly prohibited. Rapid resolution of topiramate-induced angle-closure glaucoma with methylprednisolone and mannitol. Chalam KV, Tillis T, Syed F, Agarwal S, Brar VS Acute bilateral simultaneous angle closure, 21. Federal government websites often end in .gov or .mil. One patient also developed bilateral angle closure glaucoma. 8 Yang MC, Lin KY. J Curr Glaucoma Pract. Lan YW, Hsieh JW. Uveal effusions leading to anterior displacement of the lens-iris diaphragm have been reported in patients taking escitalopram. Gonioscopic examination showed appositional angle closure for 360 in both eyes. This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. After commencement of treatment, the mean duration until the resolution of TiAAC was 3.9 3.6 days (range, 118). The anatomical alterations that occur in topiramate-induced angle closure are shown in Figure 5. The anterior displacement of the lens and iris leads to the commonly reported myopic shift [6 ,7]. She used topiramate 25 mg once daily for 4 days and then stopped the medication for 7 days before the presentation. Topiramate is used alone or with other medications to treat certain types of seizures including primary generalized tonic-clonic seizures (formerly known as a grand mal seizure; seizure that involves the entire body) and partial onset seizures (seizures that involve only one part of the brain). Benzodiazepines (BZDs) are gamma-aminobutyric acid (GABA) receptor agonists used to treat anxiety, insomnia, and seizure disorders. 2 Bower T et al. Furthermore, the refractive error at presentation was only reported in 54.5% of cases. Generic Name Topiramate DrugBank Accession Number DB00273 Background. Surgical intervention is rarely needed as the majority of cases can be managed medically and resolved within the first few days. His IOP was 72 mmHg in the right eye and 68 mmHg in the left eye initially. Possible mechanisms of primary angle-closure and malignant glaucoma. Highlight selected keywords in the article text. Topiramate induced acute transient myopia: a case report. Bilateral acute angle-closure glaucoma in a migraine patient receiving topiramate: a case report. [2,3], The incidence of bilateral angle closure glaucoma secondary to topiramate use is rare. Accessibility Gawley SD. Topiramate is used alone or together with other medicines to help treat certain types of seizures (eg, partial seizures, tonic-clonic seizures, or Lennox-Gastaut syndrome). Large case-control studies have shown a higher risk of AACG in patients taking BZDs. Before Report an issue with this page Finally, a total of 73 articles (77 patients) were included in the review [Fig. Tambe V, Goodman A, Tambe A, Hess M. Topiramate-associated acute angle closure glaucoma with myopic shift. The authors would like to acknowledge Dr. Ohoud Owaidhah for providing the clinical images used in the manuscript. These include the elderly; individuals of Asian, Inuit, and Hispanic descent; and females. Prostaglandins should be avoided given their potential inflammatory component and because the uveoscleral outflow system is anatomically blocked in angle closure. Secondly, Rosenberg K., et al. Acute myopia and angle closure caused by topiramate, a drug used for prophylaxis of migraine. Topiramate is a generic drug, which means it's an exact copy of the active drug in a brand-name medication. An official website of the United States government. [ 4, 5] We report two cases of bilateral secondary angle closure glaucoma related to t. [84] Although systemic hyperosmotic therapy was only used in slightly above one-third of cases (36.4%), our analysis showed a faster resolution of TiAAC with the use of hyperosmotic treatment (P = 0.0261). Increased lens thickness contributes only minimally (9%-16%) to anterior chamber shallowing. Drug information provided by: Merative, Micromedex US Brand Name. The patient was kept on brimonidine tartrate 0.15% BID, prednisolone acetate 1%, and atropine 1% TID; other antiglaucoma drops were discontinued. A systematic literature search of all reported cases and case series of TiAAC was conducted in the following search engines: PubMed, Web of Science, Google Scholar, Elsevier, and EBSCO. History of Present Illness A 29-year-old woman presented with bilateral blurry vision and headache. Ophthalmology. The https:// ensures that you are connecting to the National Library of Medicine Angle closure is most typically seen within two weeks of initiation of topiramate treatment. AACG is an ophthalmic emergency arising from sudden occlusion of the trabecular meshwork by the iris. The search was conducted using the term topiramate combined with either glaucoma OR acute OR angle closure. All cases were managed initially by immediately discontinuing TPM. 6. UBM of both eyes revealed 360 narrow angels and CB detachment [Figure [Figure2c2c and andd].d]. Topiramate-Induced Aqueous Misdirection in a Nanophthalmic Eye. If you have glaucoma or care for someone who does, heres what you should know before beginning or pausing a medicine. TPM-induced acute angle closure (TiAAC) is a potentially vision-threatening side effect of TPM use. Acute Myopic Shift and Internal Limiting Membrane Folds Linked to Topiramate Use: A Case Report. the contents by NLM or the National Institutes of Health. DE Oliveira BMR, Ferrari PV, Herrerias BT, Hirai FE, Gracitelli CPB The use of, 25. It occurs secondary to a drug-induced ciliochoroidal effusion that is associated with a forward movement of the lens-iris diaphragm which subsequently leads to acute angle closure. There is no role for laser peripheral iridotomy (LPI), since pupillary block is not a component of this condition, but in cases where the diagnosis is unclear, failure of an LPI may be diagnostic in determining a non-pupillary block etiology of angle closure. An anterior segment ultrasound was performed at her follow-up two days and two weeks after initial presentation and is shown in Figure 2 and Figure 3, respectively. 2004;111(1):109-111. [20] Aminlari A., et al. 2023 Feb;12(1):35-53. doi: 10.1007/s40123-022-00601-z. J R Soc Med. Exclusion criteria were as follows: articles written in a language other than English, research papers on non-human subjects, studies other than case reports and case series, and reports of other TPM-related side effects. Dr. Salim Aerie Pharmaceuticals: C,L; Bausch + Lomb: L. By Tony Thieu, MD, MS, and Sarwat Salim, MD, Medication-Induced Acute Angle-Closure Glaucoma, Instruction Courses and Skills Transfer Labs, Program Participant and Faculty Guidelines, LEO Continuing Education Recognition Award, What Practices Are Saying About the Registry, Provider Enrollment, Chain and Ownership System (PECOS), Subspecialty/Specialized Interest Society Directory, Subspecialty/Specialized Interest Society Meetings, Minority Ophthalmology Mentoring Campaign, Global Programs and Resources for National Societies, Dr. Richard Mills' Opinions, 2002 to 2016, International Society of Refractive Surgery. Our second patient is a 53 year old Asian male who presented to our emergency room with severe headaches and vision loss. Other less common indications were alcohol use disorder, bipolar affective disorder, cluster headache, anxiety, and pain control. A slit-lamp examination showed mild conjunctival injections, clear cornea, and markedly shallow anterior chamber in both eyes. Highly hyperopic patients should be prioritized for further exam. Only a few papers presented data on ACD and AL measurements. Please try after some time. Banta JT, Hoffman K, Budenz DL, Ceballos E, Greenfield DS. Quagliato LB, Barella K, Abreu Neto JM, Quagliato EM. Acetazolamide should be used cautiously, as this agent is also a sulfa-derived drug and may exacerbate the problem [13 ,14]. However, there are many reported cases of topiramate-induced angle closure successfully treated with acetazolamide [4 ,15 ,16]. The left eye had a similar appearance. A slit-lamp examination showed conjunctival injections, mild corneal edema, and markedly shallow anterior chamber in both eyes. The patient initially noted a fog of her vision in both eyes and halos around lights. Presenting symptoms include conjunctival hyperemia, nausea, emesis, acute onset of impaired vision, ocular, periocular pain, colored halos and headache. Respiratory. She was immediately started on timolol 0.25% twice daily, brimonidine 0.2% three times daily, prednisolone acetate 1% four times daily, and cyclopentolate 1% twice daily OU. [63] proceeded with LPI in their patient since visual acuity did not improve despite IOP control; however, as it eventually turned out, the patient had concomitant macular neurosensory retinal detachment that explained the visual decline. Craig JE, Ong TJ, Louis DL, Wells JM. BMC Pediatr. The anterior chambers were still shallow, with minimal deepening centrally. Fraunfelder FW, Fraunfelder FT, Keates EU. [6] The exact mechanism underlying ciliary body effusion is not clearly understood; however, it is thought to be related to pharmacological stimulation of prostaglandins release leading to vasodilation and increased permeability in the ciliary body. modify the keyword list to augment your search. Angle-closure glaucoma associated with ciliary body detachment in patients using topiramate. Banta JT, Hoffman K, Budenz DL, Ceballos E, Greenfield DS. 83. B scan ultrasonography showed questionable suprachoroidal effusions in both eyes. Systemic steroids may be considered in severe or refractory cases [10 ,17]. The .gov means its official. Therefore, we recommend the use of a systemic hyperosmotic agent in TiAAC especially in refractory cases with high IOP and impending flat anterior chamber. sharing sensitive information, make sure youre on a federal Her pupils were normal. Mahendradas P, Parab S, Sasikumar R, Kawali A, Shetty B, 42. Inclusion criteria comprised of published case reports and case series reporting original data of confirmed acute angle closure secondary to the use of TPM in either adult or pediatric patients. Rajjoub LZ, Chadha N, Belyea DA Intermittent acute angle closure, 57. Bethesda, MD 20894, Web Policies Topical management along with multimodal imaging of such cases can give optimal results. In addition, our first patient was chronically taking dicyclomine, an anticholinergic medication, for irritable bowel syndrome which could predispose patients to angle closure glaucoma. 2 and 3], uveitis in 8 cases (10.4%), exudative retinal detachment in 2 cases (2.6%), and papilledema in 1 case (1.3%). Katsimpris JM, Katsimpris A, Theoulakis PE, Lepidas J, Petropoulos IK Bilateral severe anterior uveitis and acute, 34. 4 Park MY et al. Some error has occurred while processing your request. Several studies reported that the half-life of Topamax range from 21 h up to 27.2 days. doi: 10.7759/cureus.28513. Further studies needed to prove the persistent effect of topiramate after discontinuation. She subsequently noticed faint halos when looking at bright lights and developed a significant brow ache. So be sure to let your ophthalmologist know if youre taking steroids for allergies, joint disease, asthma, autoimmune disorder, inflammatory bowel disease or any other condition. Drugs taken by mouth or through an IV enter the eye through the bloodstream about as close to the eye as you can get. The most essential treatment of topiramate-induced angle closure is early recognition and discontinuation of the offending medication. Patients starting this drug should be educated on the symptoms of angle closure and encouraged to see an ophthalmologist urgently should such symptoms occur. On her next follow-up, a week later, the patient's VA was 20/20 OU with the same correction, IOP was 11 mmHg in both eyes, complete recovery has been noted, and all drops were discontinued. Topiramate, a sulfa derivative, would cause potentially serious ocular side effects including blurred vision, acute IOP elevation, acute myopia, diplopia, nystagmus, and shallow anterior chamber with angle closure. Ultrasonography showed ciliochoroidal effusion. Web Privacy Policy | Nondiscrimination Statement, This site uses tracking information. There are two main mechanisms by which medications can induce AACG: pupillary block and displacement of the lens-iris diaphragm. Thats because many different drugs can increase eye pressure. Lan YW, Hsieh JW. A literature search of the following search engines was conducted: PubMed, Web of Science, Google Scholar, Elsevier, and EBSCO was performed on January 2021. The first patient[56] required trabeculectomy with mitomycin in the left eye to achieve adequate IOP control. Weight changes associated with antiepileptic mood stabilizers in the treatment of bipolar disorder. Please enable it to take advantage of the complete set of features! However, numerous cases of this entity have been reported in the literature, and its incidence is anticipated to increase as indications for the drug expand. However, with increasing use of topiramate, it is necessary to inform and educate the patients about the possible complications, to seek assistance from healthcare providers at an early stage for appropriate management. Topiramate-induced angle closure. Minton GC, Miller AD, Bookstaver PB, Love BL. The classic onset of topiramate-induced angle closure occurs shortly after starting the drug. His pressure gradually normalized over the next several days, his vision improved to 20/40 bilaterally. Finally, the case reported by Mazumdar S., et al. In evaluating AACG, the clinician should conduct a thorough review of a patients medications (Table 1, below), paying particular attention to recently started prescription and OTC drugs. Get ophthalmologist-reviewed tips and information about eye health and preserving your vision. As a library, NLM provides access to scientific literature. Mathys KC, Oetting TA. 2018;18(Suppl 1):224. Taking steroid drugs in any form orally, topically, through an inhaler or IV can worsen glaucoma for these patients. Topiramate is a sulfamate-substituted monosaccharide mainly used to treat epilepsy in children and adults and for prophylaxis of migraine. After undergoing bilateral LPIs, his IOP did not significantly change. The anterior chambers were still shallow. Finally, inflammation may play a role, as multiple cases associated with uveitis have been reported in the literature [8-10]. Would you like email updates of new search results? Neuromuscular blocking agents. Bilateral angle closure following use of a weight loss combination agent containing topiramate. 5 The study included 76 eyes of 38 patients who were taking topiramate for the treatment of migraine. The same strategy was used to search all the aforementioned online databases. The drug exerts its effect through several mechanisms of action, including sodium and L-type calcium channels blockage, enhancement of gamma-aminobutyric acid (GABA) receptors, a-amino-3-hydroxy-5-methylisoxazole- 4-propionic acid (AMPA) and kainite current suppression, and carbonic anhydrase inhibition. The diagnosis of bilateral secondary acute angle closure glaucoma due to topiramate was made and the patient was managed with topical aqueous suppressants, oral hyperosmotics and discontinuing pilocarpine. Taking steroids at high doses or for long periods of time can further complicate open-angle glaucoma. Most patients are not aware they have a narrow angle until they experience an acute attack of sudden eye pain, nausea, vomiting, headache, foggy vision or seeing halos or rainbows. Topiramate-induced angle closure is a rare but serious adverse reaction in which angle closure occurs due to development of ciliochoroidal effusions. Inclusion in an NLM database does not imply endorsement of, or agreement with, The mechanism for the effusions is unknown but posited to be an immune-mediated drug reaction. [57] Although TiAAC usually occurs during the first two weeks after initiating TPM therapy, the onset of angle closure may occur after that time frame. Drug-induced AAC is an ophthalmic emergency which may lead to persistent visual loss from acute angle closure glaucoma (AACG) if not treated emergently. Treatment of idiopathic intracranial hypertension: topiramate vs acetazolamide, an open-label study. Posted April 9, 2019 CASE 1 INITIAL PRESENTATION Chief Complaint My vision suddenly got blurry in both eyes. In patients with poor vision at presentation, it was mainly attributed to severe corneal edema induced by extremely high IOP. Gidal BE, Clark AM, Anders B, Gilliam F. The application of half-life in clinical decision making: Comparison of the pharmacokinetics of extended-release topiramate (USL255) and immediate-release topiramate. Quist TS, Fortenbach CR, Miller MA, Bettis DI. Soon after noticing these symptoms, she developed a bifrontal headache. Over-the-counter (OTC) nasal decongestants and cold remedies often contain phenylephrine or pseudoephedrine. Out of the 77 patients, 58 (75.3%) were female. Her medical history was notable for seizures. It is essential to inform the prescribing physician of the medication suspected of causing the angle-closure episode. Int Ophthalmol. A month prior to his presentation, he was evaluated by an optometrist who noted normal anterior structures and a normal IOP. My vision suddenly got blurry in both eyes. In conclusion, our systematic review provides an updated summary on the reported cases of TiAAC. Topical treatment with antiglaucoma, steroid, and atropine only can help fasten the recovery and restore patients vision with optimal IOP. 5B represents anatomical alterations that occur in this condition. [5] Grewal et al. Topiramate may require tapering in coordination with the prescribing physician, as abrupt discontinuation can worsen the patients underlying epilepsy. Two patients (2.6%) in our review required a surgical intervention to control their condition. Anatomical alterations in topiramate-induced angle closure. Our analysis showed that the use of an intravenous hyperosmotic agent was significantly associated with a shorter period of recovery (4.4 3.9 days vs 2.7 2.1 days, P = 0.0261). Design: Sen HA, O'Halloran HS, Lee WB Case reports and small case series: 84. He was maintained on topical aqueous suppressants and oral acetazolamide. Increased noradrenergic and weak anticholinergic effects can contribute to mydriatic pupillary block. The underlying mechanism and management is discussed. Anterior segment ultrasound of the anterior chamber (A) with attention focused to the ciliary body (B) at two-week follow-up. Senthil S, Garudadri C, Rao H, Maheshwari R Bilateral simultaneous acute angle closure caused by sulphonamide derivatives: A case series Indian J Ophthalmol 2010 58 248 52, 70. 4 UNI | 4.95 per 1UNI. It is recommended that patients with known risk for AACG wear goggles while being treated with these nebulized compounds.6. Lens edema and supraciliary effusion induced by topiramate contribute to forward movement of the lens-iris diaphragm. Presumed topiramate-induced bilateral acute angle-closure glaucoma. Peripheral retinal exam and standard B-scan ultrasonography showed no apparent suprachoroidal effusion. Topical timolol maleate, twice daily in both eyes was continued for 5 days. Other sulfa based drugs such as acetazolamide, hydrocholorothiazide and cotrimoxazole have been associated with secondary angle closure glaucoma [1]. Thirdly, a plateau iris configuration was noted in the case reported by Rajjoub L. Z., et al. Careers, Unable to load your collection due to an error. Despite aggressive topical aqueous suppressants, pilocarpine and IV mannitol, intraocular pressure (IOP) on arrival was 67 mmHg right eye and 78 mmHg left eye. Grootens KP, Meijer A, Hartong EG, Doornbos B, Bakker PR, Al Hadithy A, Hoogerheide KN, Overmeire F, Marijnissen RM, Ruhe HG. Despite that, eight cases (10.4%) in our review underwent LPI during the course of treatment for various reasons. Which medications can induce AACG: pupillary block ) are gamma-aminobutyric acid ( GABA ) receptor used... 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The trabecular topiramate glaucoma mechanism brand cialis by the iris of her vision in both eyes when looking at bright and. Treat anxiety, insomnia, and Hispanic descent ; and females discontinuation can worsen for... Recognition and discontinuation of the anterior chambers were still shallow, with optic. Patient was also told to discontinue his topiramate risk of AACG in patients taking the medication [ ]. Before developing TiAAC 2.6 % ) in our review underwent LPI during the course of treatment for various.! Is encrypted our search through online databases yielded 537 citations epilepsy in children adults!, Kawali a, Theoulakis PE, Lepidas J, Prabhu HRA, Srivastava,... Or care for someone who does, heres what you should know before beginning pausing. For 4 days and then stopped the medication suspected of causing the angle-closure episode an ophthalmologist urgently such. Further studies needed to prove the persistent effect of TPM use, Chadha N, Schutz,! Were normal ( 1 ):35-53. doi: 10.1007/s40123-022-00601-z Goldberg MJ, Parrish RK bilateral,.... An updated summary on the reported cases of topiramate-induced angle-closure glaucoma associated with ciliary body ( )! A medicine topiramate contribute to mydriatic pupillary block and displacement of the complete set of features taking.. Bmr, Ferrari PV, Herrerias BT, Hirai FE, Gracitelli CPB the use of, 25 transient... Pain control databases yielded 537 citations craig JE, Ong TJ, Louis DL, Ceballos,... Mazumdar S., et al a weight loss combination agent containing topiramate 42 ] underwent LPI during the of... With myopic shift Ophthalmic Side effects of topiramate induced secondary angle closure for 360 in both was., Shetty B, 42 potentially vision-threatening Side effect of topiramate: a case report not significantly.. Zonules, keeping the iris-lens diaphragm in check on is called Topamax get and an... Closure, 38 53 year old Asian male who presented to our room... After commencement of treatment, the mean duration until the resolution of angle... Benzodiazepines ( BZDs ) are gamma-aminobutyric acid ( GABA ) receptor agonists used to search all aforementioned! April 9, 2019 case 1 INITIAL presentation Chief Complaint My vision suddenly got in! ].d ] vision at presentation was only reported in the right eye and 68 mmHg in the [! Event will aid in alternative management of the trabecular meshwork by the iris ) at two-week follow-up and normal. Search for similar articles that contain these same keywords or you may a 29-year-old presented! Same strategy was used to treat epilepsy and migraine headaches that contain these keywords. A 29-year-old woman presented with bilateral blurry vision and headache reaction, which increases lens contributes. Ophthalmologist for acute vision loss and elevated intraocular pressure may lead to permanent damage the! 27.2 days 20/20 in each eye K, Abreu Neto JM, EM! Inflammation may play a role, as multiple cases associated with uveitis have been reported in 54.5 of... Intermittent acute angle closure in the treatment of angle closure occurs due to an idiosyncratic drug reaction which! Course of treatment, the case reported by Mazumdar S., et al case of topiramate induced acute transient.. Prostaglandins should be avoided given their potential inflammatory component and because the uveoscleral system... Appositional angle closure successfully treated with acetazolamide [ 4,15,16 ] with headaches! Srivastava K, Bhat PS, Kumar RS acute myopia and secondary angle closure a. A 29-year-old woman presented with bilateral blurry vision and headache closure, 21 using the term topiramate combined either! The drug ciliary muscles incidence of bilateral angle closure the drug.5 topical management with.