Cefixime-induced angle closure and transient myopic shift in a healthy individual; A case report

To report a case of Acute bilateral angle closure and Myopia following oral Cefixime therapy for pharyngitis.

A 49-year-old man presented to the clinic with a history of aggravating ocular pain and blurry vision in both eyes from 5 days ago. He was under treatment with oral Cefixime 400 mg twice a day for acute bacterial pharyngitis since last week. His refractive error was -3.75 and -4.25 diopters in the right and left eye respectively. Intraocular pressure (IOP) was 32 mm Hg in the right eye and 40 mm Hg in the left eye. Slit lamp examination and gonioscopy showed shallow anterior chamber with 360° appositional angle closure. Ultrasound biomicroscopy revealed shallow anterior chamber, narrow angle, supraciliary effusion and anterior rotation of ciliary body in both eyes. With diagnosis of drug-induced acute angle closure, oral Cefixime was discontinued and eye drops Betamethasone every 4 hours, Cosopt and Brimonidine twice a day, and Atropine 1% twice a day were started. Few days after starting treatment all ocular symptoms and signs were resolved.

Systemic Cefixime can induce acute angle closure disease with myopic shift and elevated IOP secondary to supraciliary effusion and ciliary body rotation.