Acute myopia and angle closure glaucoma from topiramate in a seven-year-old: a case report and review of the literature

Abstract

BackgroundA case is reported of acute bilateral myopia and angle closure glaucoma in a 7-year-old patient from topiramate toxicity. This is the second known reported case of topiramate induced acute angle closure glaucoma and third known reported case of topiramate induced acute myopia in a pediatric patient.Case presentationThis case presents a 7-year-old who had recently begun topiramate therapy for seizures and headache. She developed painless blurred vision and acute bilateral myopia, which progressed to acute bilateral angle closure glaucoma. After a routine eye exam where myopia was diagnosed, the patient presented to the emergency room with symptoms of acute onset blurry vision, tearing, red eyes, swollen eyelids, and photophobia. The symptoms, myopia, and angle closure resolved with topical and oral intraocular pressure lowering medications, topical cyclopentolate, and discontinuation of topiramate.ConclusionAcute angle closure glaucoma is a well-known side effect of topiramate, but is rarely seen in children. It cautions providers to the potential ophthalmic side effects of commonly used medications in the pediatric population. It highlights the need to keep a broad differential in mind when encountering sudden onset blurry vision in the primary care clinic, the need for careful consideration of side effects when starting topiramate therapy in a child, and the need for parental counseling of side effects.

The effects of methylphenidate on refraction and anterior segment parameters in children with attention deficit hyperactivity disorder

“…This study is limited by the small sample size and short follow-up period. Eighty-five percent of cases of IOP elevation associated with topiramate occur within 2 weeks of beginning treatment, 23 but the most severe reported case of IOP elevation associated with methylphenidate was detected after 2 years of treatment. 20 All of our patients were white, and our data may not be generalizable to other races.…”

“…At least 2 pediatric cases of acute myopia and acute angle closure glaucoma that developed after topiramate treatment have been reported. 22,23 The mechanism underlying this adverse effect is suspected to be ciliochoroidal. [23][24][25] Pentacam imaging was used to evaluate changes in the anterior chamber after the start of methylphenidate treatment.…”

“…22,23 The mechanism underlying this adverse effect is suspected to be ciliochoroidal. [23][24][25] Pentacam imaging was used to evaluate changes in the anterior chamber after the start of methylphenidate treatment. This noninvasive, noncontact imaging modality uses a single rotating Scheimpflug camera to obtain quantitative and reproducible data.…”

Epilepsy in Sturge-Weber syndrome: a literature review and description of a clinical case

“…Топирамат и вальпроевая кислота являются препаратами третьей линии. Следует учитывать, что топирамат, особенно в педиатрической практике, нужно использовать осторожно из-за риска обострения глаукомы [14]. Возможно, могут быть эффективными метаболические подходы, такие как кетогенная или модифицированная диета Аткинса [15].…”

Acute angle-closure glaucoma caused by topiramate–a drug complication that can lead to blindness

“…After oral intake, topiramate is promptly absorbed and crosses the blood-brain barrier. 5 It is largely eliminated in the urine and has an elimination half-life of 21 hours. 5 Most usual adverse reactions are weight loss and nervous disorders, with ocular injury being uncommon.…”