The Use of Topiramate for Weight Loss Causing Acute Glaucoma: A Case Report and Literature Review

Abstract

Topiramate is a sulfa-containing drug which is able to disrupt the ocular blood barrier. Recently it has gained more popularity, being used in many clinical conditions. Nowadays, the cases of glaucoma induced by topiramate have increased due to the use of this drug to induce weight loss. We here described a 29-year-old female presented with a one-day history of blurred vision in both eyes and headache. She was using a weight loss formula containing topiramate 100 milligrams. Ophthalmologic exam revealed an important myopic shift of -7.00 spherical diopters at presentation with intraocular pressure (IOP) of 32 mmHg and a shallow anterior chamber in both eyes. After discontinuous of topiramate and use of cycloplegic eyedrops, myopic shift improved and IOP controlled after two days. The anterior chamber was significantly deeper in both eyes after two weeks. It is theorized that topiramate can provoke a ciliochoroidal effusion and, therefore, can cause an anterior displacement of lens-iris diaphragm with a secondary angular closure. The treatment must include cycloplegic and discontinuation of the drug. Sulfa-containing drugs lead to an indirect mechanism of angle closure, frequently bilateral and, as mentioned above, with a different treatment approach. If unrecognized and untreated, it can provoke high morbidity with possibility of bilateral permanent visual loss.

Keywords: Angle-Closure Glaucoma; Ciliochoroidal effusion; Myopic shift; Topiramate; Weight loss.

Figure 1

Anterior segment opticalCoherence Tomography (OCT) Showing Bilateral Appositional Angle Closure. OD: Right Eye; OS: Left Eye.

Figure 2

Anterior Chamber Depth (ACD) Evaluation at Admission (2A) and after Two Weeks of Treatment (2B). CCT: Central Corneal Thickness; µm: micrometer.