Topiramate-induced acute bilateral angle closure and myopia: pathophysiology and treatment controversies.

Objective: To discuss the unusual features of topiramate-induced acute angle closure glaucoma, its pathophysiologic mechanisms, and treatment controversies, and to report the first anterior segment optical coherence tomography (OCT) of this condition.

Methods: Literature review and case report with OCT findings.

Results: Topiramate-induced angle closure is usually bilateral and associated with acute myopia; the ocular pressure is often not very highly elevated. Ciliochoroidal detachment with ciliary body anterior rotation is typically present and was demonstrated easily in our case with anterior segment OCT. Pilocarpine exacerbates this condition and peripheral iridotomy is not indicated, nor is iridoplasty. Treatment consists of replacing topiramate with appropriate medication, strong cycloplegia, and topical steroids.

Conclusions: It is important to recognize this form of acute secondary angle closure in order to treat it properly, avoiding harmful medication and unnecessary surgery.