Mechanism of topiramate-induced acute-onset myopia and angle closure glaucoma

Am J Ophthalmol. 2004 Jan;137(1):193-5. doi: 10.1016/s0002-9394(03)00774-8.


Design: Interventional case report.

Methods: In an institutional practice setting, two women, aged 25 and 45, developed acute myopia after starting topiramate for epilepsy. One patient also developed bilateral angle closure glaucoma.

Results: Topiramate was discontinued. Anterior chamber shallowing was noted in both patients at presentation. Ultrasonography showed ciliochoroidal effusion. Baseline measurements of anterior chamber depth and lens thickness were obtained.

Conclusions: Topiramate may be associated with ciliochoroidal effusion with forward displacement of the lens-iris diaphragm and anterior chamber shallowing, resulting in acute myopia and angle-closure glaucoma. Increased lens thickness contributes only minimally (9%-16%) to anterior chamber shallowing.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Adult
  • Anterior Chamber / diagnostic imaging
  • Anterior Chamber / pathology
  • Anticonvulsants / adverse effects*
  • Epilepsy / drug therapy
  • Female
  • Fructose / adverse effects*
  • Fructose / analogs & derivatives*
  • Glaucoma, Angle-Closure / chemically induced*
  • Glaucoma, Angle-Closure / diagnostic imaging
  • Glaucoma, Angle-Closure / physiopathology
  • Humans
  • Intraocular Pressure
  • Middle Aged
  • Myopia / chemically induced*
  • Myopia / diagnostic imaging
  • Myopia / physiopathology
  • Topiramate
  • Ultrasonography


  • Anticonvulsants
  • Topiramate
  • Fructose