Abstract

Topiramate is an anticonvulsant widely used for epilepsy treatment and migraine prevention. Its rare but very important side effects are nausea, vomiting, ocular pain and blurry vision in both eyes – topiramate induced acute angle closure. Around two weeks after initiating treatment with topiramate in some patients, the medication may cause ciliary effusion, thus moving the iris-lens complex anteriorly and closing the anterior angle. Intraocular pressure (IOP) rises, causing further side effects. The easiest and most important treatment is to stop taking topiramate. Additionally, topical and oral glaucoma medication, steroids, and cycloplegics are useful for lowering lOP and relieving the symptoms. Usually, the prognosis is good, resolving in a few days. Visual acuity and accommodation may take a few weeks to return to normal. If the diagnosis is delayed, elevated ocular pressure may lead to permanent damage to the optic nerve.