Topiramate-induced bilateral acute angle-closure attack

Topiramate, a sulfonamide-derived drug, is not only approved as an anticonvulsant but also for migraine prophylaxis. Ocular side effects are rare.

The case of a 25-year-old woman with bilateral topiramate-induced angle-closure attack is presented. Clinical findings included elevated intraocular pressure, reduced anterior chamber depth, iridotrabecular contact, thickening of the lens, forward displacement of the iris–lens diaphragm, myopic shift and uveal effusion. Non-invasive techniques such as anterior segment optical coherence tomography (AS-OCT) and B‑scan ultrasonography were used to confirm the diagnosis. Under discontinuation of topiramate, aqueous suppressants, cycloplegia and corticosteroids, symptoms and findings were reversible.

The aim is to raise awareness of possible side effects of topiramate among ophthalmologists and neurologists in order to avoid permanent visual impairment due to delayed diagnosis and treatment.