Articles about Eye Health and Disease 2004
 

Topamax (topiramate) Associated with Acute Bilateral Angle Closure Glaucoma

(From Fraunfelder FW, et al. Ophthalmology. 2004;111(1):109-111)


Topiramate (Topamax), a new novel anticonvulsant (anti-seizure) medication, is increasingly being used in the treatment of refractory mood disorders such as bipolar disorder.  It might often be used in cases of migraine or cluster headache.  It has been associated with the development of an acute angle closure glaucoma in some individuals.  Symptoms have typically occurred within the first month of therapy, with patients reporting an acute onset of decreased visual acuity and/or ocular pain. Eye examination revealed myopia, redness, shallowing of the anterior chamber and elevated ocular pressure, with or without pupil dilatation. Effusion of fluid in the ciliary body or suprachoroidal space of the eye may displace the lens and iris anteriorly (toward the front of the eye), secondarily causing angle closure glaucoma.

In the study cited above, 115 case reports, primarily of a specific ocular syndrome (acute secondary angle-closure glaucoma), were collected from spontaneous reporting systems: the Drug Safety section of Ortho-McNeil Pharmaceuticals, Inc. (Raritan, NJ), the Food and Drug Administration (Rockville, MD), the World Health Organization (Uppsala, Sweden), the National Registry of Drug-Induced Side Effects (Casey Eye Institute, Oregon Health & Science University, Portland, Oregon), and the world literature.

Eighty-six cases of acute-onset glaucoma (83 bilateral and 3 unilateral), 17 cases of acute bilateral myopia (up to 8.75 diopters), 9 cases of suprachoroidal effusions, 3 cases of periorbital edema, and 4 cases of scleritis were reported. In those cases for which management was reported, 38% had laser or surgical peripheral iridectomy (21 cases).

Conclusions:

In the “certain” category of the World Health Organization classification system, the following are caused by topiramate therapy: abnormal vision, acute secondary angle-closure glaucoma, acute myopia, and suprachoroidal effusions. All findings are reversible if recognized early and if the drug is discontinued. The first presenting symptom of acute secondary angle-closure glaucoma in many patients was blurring of vision. Peripheral iridectomy is ineffective for this type of angle-closure glaucoma.

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