Topiramate Induced Bilateral Myopia: A Potential Precursor to Acute Angle Closure Glaucoma

Acute angle closure glaucoma is a well-described vision-threatening emergency that must be promptly identified and addressed by the emergency medicine clinician. The classic presentation of unilateral eye pain, vision changes, and increased intraocular pressure is a description of a primary angle closure. This process can also occur secondarily to structural changes, systemic diseases, and certain medications.

We present a case of acute onset of myopia in the setting of topiramate use. Initial ocular examination revealed no abnormalities in intraocular pressure or slit lamp examinat, however, prompt ophthalmological evaluation revealed narrowed angles bilaterally, resulting in surgical fixation to prevent progression into angle closure glaucoma. WhyShould anEmergencyPhysicianBeAware ofThis? Acute angle closure secondary to extra-ocular etiologies is a less well-known presentation. In contrast to primary acute angle closure in which patients classically have unilateral pain and redness, these patients may present with painless, bilateral vision changes. Emergency providers must maintain a high clinical suspicion to recognize this condition that can progress to angle closure glaucoma if untreated.