This paper reports a clinical case of uveal effusion in both eyes causing bilateral acute
angle closure glaucoma in a young patient after
oral administration of
topiramate, a new
anticonvulsant medication. Rarely, some drugs have produced uveal effusions, forward shift of the iris-lens diaphragm, transient
myopia and secondary
angle closure glaucoma. A 40-year old white woman was seen at the emergency department of the "Hospital Banco de Olhos de Porto Alegre (RS)"--Brazil, with severe
headaches and blurry vision in both eyes. Her medications included
topiramate, started 10 days before.
Slit lamp examination revealed conjunctival injection, chemosis and shallow anterior chambers. Intraocular pressure measured 40 and 38 mmHg. Fundoscopic examination findings were normal. Ultrasound scan was performed and demonstrated separation between the choroidal layer and the sclera. A diagnosis of bilateral uveal effusion associated with the use of oral
topiramate was made.
Topiramate was then discontinued. The patient reported symptomatic improvement by the third day after initial examination. Symptoms were resolved and visual acuity returned to normal.
Topiramate may cause ciliary body
edema and relaxation of zonules, which induces a forward shift of the lens-iris diaphragm with acute
myopia and angle closure. As the mechanism of angle closure does not involve pupillary block, peripheral
iridectomy and topical
miotics are not useful in the treatment of this type of secondary
angle-closure glaucoma.
Drug-induced uveal effusions occur rarely. The patient improved after
topiramate discontinuation.