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Topiramate – Angle-Closure Glaucoma — SCE Neurology MCQ

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HardHeadache & Facial PainTopiramate – Angle-Closure GlaucomaSCE Neurology

Two weeks after topiramate was started for migraine, a patient develops bilateral ocular pain, blurred distance vision, a marked myopic shift, shallow anterior chambers and raised intraocular pressure. Which mechanism best explains this presentation?

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Correct answer: A — Supraciliary effusion causing anterior displacement of the lens–iris diaphragm

Topiramate-associated acute myopia and secondary angle closure is caused by supraciliary effusion with anterior movement of the lens–iris diaphragm, not conventional pupillary block. Therefore the bilateral onset, myopic shift and temporal relationship are important clues. The medicine should be stopped rapidly, as clinically feasible, and intraocular pressure treated urgently with ophthalmology input. Miotic treatment aimed at primary pupillary block does not address the mechanism.

Reference: Topiramate Mylan 100 mg tablets — Summary of Product Characteristics. https://www.medicines.org.uk/emc/product/15978/smpc