Topiramate-induced ocular complications: case series

Area of Science:

• Ophthalmology
• Neurology
• Pharmacology

Background:

• Topiramate, a sulfonamide derivative, is widely prescribed for migraine prophylaxis, epilepsy, bipolar disorder, and alcoholism.
• Ocular adverse effects, though rare, can be vision-threatening if not identified early.
• The overall risk of adverse reactions to Topiramate is approximately 3%.

Observation:

• This case series focuses on patients experiencing ocular complications after initiating Topiramate treatment.
• Patients presented with acute symptoms including blurred vision and significantly elevated intraocular pressure.
• These symptoms emerged following a prescription for Topiramate, often for headache management.

Findings:

• Topiramate is associated with a spectrum of ocular side effects, including choroidal effusion syndrome, acute angle closure glaucoma, myopic shift, visual field defects, and eyelid myokymia.
• The presented cases highlight the potential for rapid onset of these complications.
• Prompt discontinuation of Topiramate and appropriate medical intervention are crucial for managing these adverse effects.

Implications:

• Early recognition of Topiramate-induced ocular complications is critical to prevent irreversible vision impairment.
• Ophthalmologists and neurologists should maintain a high index of suspicion for these side effects in patients on Topiramate.
• Timely intervention, including drug cessation and medical treatment, leads to a favorable prognosis and visual recovery.