Refractory topiramate-induced angle-closure glaucoma in a man: a case report

A 39-year-old Caucasian man presented with acute angle-closure glaucoma; he initially presented with intractable headaches after being treated with an escalating dose of topiramate. Clinical signs included elevated intraocular pressure that was initially refractory to treatment, shallow anterior chambers, and extensive bilateral choroidal effusions. After treatment with intravenous methylprednisolone, in conjunction with conventional glaucoma treatment, there was rapid reduction of intraocular pressure, gradual delayed resolution of the choroidal effusion and induced myopic shift; and eventually a good outcome without optic nerve damage.This case illustrates the importance of recognizing this entity in a non-ophthalmic setting and that intravenous methylprednisolone may be useful in the treatment of the condition when it is not responsive to conventional treatment. In addition, it is important to recognize that complete resolution of visual symptoms from the myopic shift may be delayed, despite normalization of intraocular pressure.We report a case of topiramate-induced angle-closure glaucoma (TiACG) that was initially refractory to conventional treatment. This case illustrates the importance and method of timely and proper diagnosis, as well as management of such cases that might initially respond poorly to treatment.A 39-year-old Caucasian man, with a past medical history of hypertension and migraine headaches, presented to the emergency department with a one-day history of left-sided headache with blurred vision and haloes around lights, which rapidly progressed to involve the right side. After initial computed tomography of the head, which was unremarkable, he was admitted to the hospital with the diagnosis of intractable headaches and treated with intravenous morphine and topiramate. The following morning, the patient's ocular complaints worsened, and the ophthalmology service was consulted.Further questioning revealed that the patient had been started on topir