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[Bilateral angle-closure glaucoma induced by trimetoprim and sulfamethoxazole combination: case report]

Viviane Souto Spadoni1, Melissa Manfroi Dal Pizzol, Carlos Henrique Gervini Muniz

  • 1Serviço de Oftalmologia, Hospital de Clínicas, Porto Alegre, RS, Brasil. vspadoni@terra.com.br

Arquivos Brasileiros De Oftalmologia
|September 5, 2007
PubMed

Insights

Sulfamethoxazole-trimethoprim (cotrimoxazole) can cause a rare eye syndrome. This case highlights an unfavorable outcome despite early drug withdrawal, leading to vision loss.

Area of Science:

  • Ophthalmology
  • Pharmacology
  • Toxicology

Background:

  • Sulfamethoxazole-trimethoprim (cotrimoxazole) is a common antibiotic.
  • Sulfonamides, including cotrimoxazole, are linked to a rare syndrome of choroidal effusion, transient myopia, and angle-closure glaucoma.

Observation:

  • A 49-year-old man developed severe ocular pain, hyperemia, chemosis, and extremely high intraocular pressure (over 50 mmHg) with 360-degree choroidal effusion four days after starting cotrimoxazole for Pneumocystis carinii prophylaxis.
  • Despite prompt withdrawal of cotrimoxazole and a decrease in intraocular pressure within four days, the patient developed total cataracts and phthisis bulbi in both eyes within two months.

Findings:

  • This case represents a rare instance of an unfavorable outcome from cotrimoxazole-induced ocular syndrome.
  • Unlike previously reported cases with complete resolution, this patient experienced irreversible vision loss despite early diagnosis and drug cessation.

Implications:

  • Early recognition of sulfonamide-induced ocular toxicity is crucial.
  • This case underscores the potential for severe, irreversible complications even with prompt management, necessitating further investigation into risk factors and treatment strategies.

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