Topiramate glaucoma with

Rhee DJ, Ramos-Esteban JC, Nipper KS. Rapid resolution of topiramate-induced angle-closure glaucoma with methylpred-nisolone and mannitol. Am J Ophthalmol 2006 141 1133-1134. 

Topiramate is recently approved by the FDA for migraine prophylaxis. Dose is initiated at 25 mg/day and increased slowly to minimize side effects, which may include paresthesias, fatigue, anorexia, diarrhea, weight loss, difficulty with memory, and nausea. Kidney stones, acute myopia, acute angle-closure glaucoma, and oligohidrosis have been infrequently reported. 

As of 17 August 2001 there were 23 reported cases (22 adults and 1 child) out of 825 000 patients. Symptoms typically occur within the first month of therapy, and the patients report acutely reduced visual acuity and/or ocular pain. There is myopia, redness, swelling of the anterior chamber, and raised ocular pressure, with or without pupil dilatation. Supraciliary effusion can displace the lens and iris anteriorly, secondarily causing angle-closure glaucoma. The symptoms are reversible if topiramate is withdrawn. Acute myopia has been described as a rare idiosyncratic reaction to other sulfonamides. It has been postulated that the pathogenic mechanism is related to partial inhibition of carbonic anhydrase and to ciliary body swelling. 

Sankar PS, Pasquale LR, Grosskreutz CL. Uveal effusion and secondary angle-closure glaucoma associated with topiramate use. Arch Ophthalmol 2001 119(8) 1210-11. 

Sensory systems Bilateral severe uveitis with angle-closure glaucoma, a rare complication of topiramate therapy, has been reported in a 49-year-old man [291 ]. 

Sensory systems There have been several cases of angle-closure glaucoma and/or acute myopia associated with topiramate [306, 307, 308 ]. 

Five patients with topiramate associated bilateral acute angle-closure glaucoma unresponsive to ocular hypotensive therapy and drug discontinuation were effectively treated with argon laser peripheral iridoplasty [336 337 ]. 

Brandao MN, Fernandes IC, Barradas FF, Machado JF, Oliveira MT. Acute myopia and angle closure glaucoma associated with topiramate use in a young patient case report. Arq Bras Oftalmol 2009 72 (1) 103-5. 

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