Topiramate: Connecting dot of acute angle closure with myopic shift and missing link with acute anterior uveitis

Abstract

An interesting case of a 38-year-old male who presented with bilateral, sudden onset, painful diminution of vision. He had raised intraocular pressure (IOP), Oculus Uterque (OU) and bilateral acute onset myopia. Ultrasound biomicroscopy (UBM) revealed bilateral (B/L) ciliochoroidal effusion. This made us revisit his history to justify the acute onset myopia associated with raised IOP, which was established to be Topiramate (TPM) induced. Fourteen days after withdrawal of TPM, he also developed unilateral acute non-granulomatous anterior uveitis that was managed conservatively. Finally, his uncorrected visual acuity was 6/6 OU, and IOP was normal without any drugs. This case illustrates the significance of meticulous history and a step-wise approach to clinch the diagnosis. It is also imperative for clinicians to recognize these conditions and educate patients about the serious adverse effects when prescribing TPM.