Review of sulfonamide-induced acute myopia and acute bilateral angle-closure glaucoma

Abstract

Sulfonamide medications can cause an idiosyncratic reaction, resulting in acute transient myopia and acute angle-closure glaucoma. The risk of an adverse reaction to a sulfonamide is approximately 3%, and the exact mechanism of the myopia and angle-closure glaucoma remains controversial. Typical clinical presentation includes bilateral involvement with blurring of vision that generally occurs over minutes to hours, nausea or vomiting, red eye, and headache. Examination may show conjunctival injection, corneal edema, anterior chamber inflammation, and flat or shallow anterior chamber. Diagnosis is based on clinical suspicion, although an ultrasound biomicroscopy may be helpful in diagnosing swelling of the ciliary body. Topiramate, a sulfa derivative, is used for the treatment of migraines or seizures. The side effects include acute myopia and angle-closure glaucoma. Treatment of this condition is primarily supportive along with discontinuation of the medication; topical miotics and peripheral iridectomy are not helpful. If intraocular pressure remains uncontrolled, additional therapies, such as topical intraocular pressure-lowering medications, high-dose steroids, and trabeculectomy, may need to be considered.