Topiramate induced angle-closure glaucoma in a healthy female: a case report

Topiramate-induced angle-closure glaucoma (ACG) is rare. This case report details an instance of secondary ACG in a young, relatively healthy female following the administration of topiramate for migraine prophylaxis. Topiramate, an antiepileptic drug, is approved in the United States for the management of seizures, prevention of migraine headaches, and in combination with phentermine, for chronic weight management therapy in adults. Clinical suspicion for topiramate-induced ACG should be high in patients presenting with the appearance of its signs and symptoms within several weeks of therapy initiation. Acute ACG is an ophthalmic emergency that can result in irreversible blindness if not promptly identified, and appropriately treated. The treatment consists of immediate discontinuation of the medication and administration of cycloplegic agents, intra-ocular pressure lowering agents, and topical and oral steroids. Prescribing physicians should identify any risk factors for the condition in patient history and weigh the benefits and risks of initiating the medication. Patients should be made aware of the possible side effects associated with the drug to make informed decisions.