Bilateral Severe Anterior Uveitis and Acute Angle-Closure Glaucoma Following Topiramate Use for Migraine Crisis

 

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Background

Topiramate (TPM) is a sulfamate-substituted monosaccharide that was initially introduced and approved by the Food and Drug Administration (FDA) in 1996 for the treatment of epilepsy [1]. It has been applied as a monotherapy or as an adjunctive drug in controlling seizures [1]. Efficacy, however, was evident in many other neurological and psychiatric conditions except seizures disorders. The use of TPM received approval for migraine prevention in 2004 by the FDA [2]. Thus, a broadening of the spectrum of TPM use was ensued, leading to a widespread use of this drug by many specialists such as neurologists, psychiatrists and primary caregivers [1], [2].

The increasing use of TPM following its first launch in 1996 caused an increase in the number and range of adverse effects of this drug [3], [4]. Systemic, neurological and ophthalmological adverse effects are the most commonly described [3], [4]. Since the first description of a case of acute angle closure glaucoma (AACG) by Banta et al. [5] in 2001, many publications have pointed out the variety and the severity of the ophthalmological side effects [3], [4], [5], [6].

As a consequence, knowledge of these complications and of their clinical presentation is of primary importance to the ophthalmologist.

We report the case of a patient who experienced severe and bilateral AACG associated with anterior uveitis and uveal effusion.

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