Dr. Ankita Patil, A15981, Dr. Anjali Nicholson
A 23 year old female came with complaints of sudden bilateral decrease of vision associated with bifrontal headache.She had history of migraine.Examination revealed best corrected visual acuity of 6/60,circumciliary congestion,sluggishly reacting pupils,shallow anterior chamber,intraocular pressure of 40 mm of Hg, closed angles bilaterally.A diagnosis of bilateral acute angle closure glaucoma was made. UBM showed supraciliary effusion and angle closure bilaterally.The patient had been started on tablet topiramate 25mg OD five days back for migraine treatment. Thus topiramate induced idiosyncratic supraciliary effusion caused bilateral angle closure.Treatment consisted of discontinuing topiramate and lowering the intraocular pressure.Topical and systemic antiglaucoma medications were prescribed to lower the IOP.Cycloplegics helped in deepening the anterior chamber.Topical and systemic steroids were also given to reduce inflammatory effusion caused by idiosyncratic reaction.