Topiramate Induced Secondary Acute Angle Glaucoma: A Case Report

This is a case of a 28-year-old Caucasian female presenting to the Emergency Department (ED) with concerns of painless, bilateral blurry vision that began suddenly the prior day and had become notably worse overnight. This case is unusual because she did not list topiramate on her medication list and did not admit to taking the medication until specifically asked. On ocular examination the patient had a visual acuity of 20/200 in both eyes, slit lamp examination showed the cornea and anterior chamber appeared normal. The intraocular pressure (IOP) was elevated with a reading of >50 mmHg in both eyes. Based on the clinical findings a diagnosis of topiramate-induced acute closed angle glaucoma was made and she was referred to Ophthalmology. Subsequent follow up occurred at four months and the patient reported resolution of her symptoms and her visual acuity returned to baseline. This case highlights the importance in performing a thorough history with a patient, which includes asking about unprescribed substances.