DR. AKULRAJ GUPTA

Dr. sapna sabnani, Dr.SANTOSH KASHYAP

Abstract

A 60 yr woman came with painful decreased vision in BE. She was known case of hypothyroidism & epilepsy, on levothyroxine & levetiracetam but recent history of breakthrough seizures started on topiramate since 3 weeks.On examination, vision was 4/60 in RE & CF 2 feet in LE. In BE there was corneal oedema, shallow ACs, flat iris, closed angles on gonioscopy, irregular & sluggishly reacting pupils. IOP was 42 & 40mm Hg in RE & LE respectively. Fundoscopy showed optic nerve oedema with blurred margins & choroidal effusion. B-scan confirmed effusion with max elevation of 7mm in RE and 3.5mm in LE. With history of starting topiramate & B/L signs suggesting drug-induced angle closure glaucoma. Topiramate was suspected to be probable cause. After discussion with physician, Topiramate was discontinued & given topical antiglaucoma medications. By Day 10 visual acuity was 6/18 in RE & 6/36 in LE. IOP was 13 & 15mm Hg in RE & LE with normal anterior segment & resolution of choroidal effusion.