Presumed bupropion-associated acute bilateral angle-closure with uveal effusions

Area of Science:

• Ophthalmology
• Pharmacology

Background:

• Bilateral acute angle closure crisis (AACC) is a serious ophthalmic condition.
• Uveal effusions can lead to secondary AACC.
• Medication-induced ocular side effects require careful consideration.

Purpose of the Study:

• To report a case of bilateral AACC secondary to uveal effusions.
• To identify a potential contributing medication (bupropion).
• To describe the management and outcome of this specific case.

Main Methods:

• Case report of a patient presenting with AACC.
• Ophthalmic examination including gonioscopy and autorefraction.
• Anterior segment imaging (OCT, ultrasound biomicroscopy) to assess uveal effusions.
• Medication review and discontinuation of suspected agent.

Main Results:

• The patient presented with bilateral AACC, high intraocular pressure (IOP), shallow anterior chambers, and uveal effusions.
• Bupropion was identified as a potential exacerbating factor.
• Discontinuation of bupropion, along with atropine, prednisolone, and IOP-lowering drops, led to IOP normalization and resolution of effusions.

Conclusions:

• Bupropion may contribute to or exacerbate uveal effusions leading to secondary AACC.
• A comprehensive medication review is crucial in managing bilateral AACC.
• Timely diagnosis and management, including medication adjustment, can effectively treat this condition.