Delayed Topiramate-induced Bilateral Angle-Closure Glaucoma

Purpose: To report a unique case of delayed topiramate-induced bilateral angle closure. Methods: A case report of a 40-year-old woman who experienced bilateral acute angle-closure glaucoma and induced myopia on a standard and consistent dose of topiramate for 262 days before the onset of symptoms. Initial and follow-up examination findings were reviewed. Results: Initial examination revealed finger counting at one foot OU, intraocular pressures of 38 mm Hg OD and 37 mm Hg OS, and bilaterally closed angles with no view of anterior trabecular meshwork (Shaffer grade 0). Discontinuation of topiramate and administration of topical drops were able to break the attack. At 3 months of follow-up, the patient was 20/25 OU with deep angles open to the scleral spur (Shaffer grade III) and had intraocular pressures of 14 mm Hg in both the eyes. Conclusions: This case provides evidence of delayed bilateral angle closure from topiramate and raises questions as to the cellular mechanism of topiramate-induced angle closure, both immediate and delayed.