FP587 : Schiempflug Imaging of Acute Myopia Secondary to Topiramate Use

Dr.Pawan Prasher, P10480

We present a case of acute myopia in a 22 year old medical student who had been recently prescribed topiramate for migraine headaches. On presentation, uncorrected visual acuity was finger counting at 2 feet in both eyes and manifest refraction was -13.5 D- 1.50 D x 15° in the right eye and -13.25 D – 1.50 x 117° in the left eye. Her previous prescription was -3.75 D- 0.5 D x 180° in the right eye and -3.50 D- 0.75 D x 180° in the left eye. Schiempflug imaging showed marked shallowing of the anterior chambers in both eyes. The acute myopia resolved three days after topiramate was discontinued and topical homatropine started. Idiosyncratic reaction to Topiramate, as a result of forward displacement of lens iris diaphragm secondary to ciliochoroidal effusion, should be suspected in the patients presenting with bilateral acute myopia. Early recognition and intervention may prevent an attack of angle closure glaucoma in these patients.