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Topiramate-Induced Myopia

2002; Wiley; Volume: 42; Issue: 1 Linguagem: Inglês

10.1046/j.1526-4610.2002.02019.x

1526-4610

Richard M. Zweifler, Mr. Brent McKinley, David Duval,

Ophthalmology and Eye Disorders

We are writing to report a case of acute myopia in a 35-year-old white woman who received topiramate for headache prophylaxis. She has no prior history of myopia and a long-standing history of episodic headache adhering to the International Headache Society (IHS) criteria for migraine without aura. Approximately 8 months prior to her initial visit, she began developing visual aura associated with some headaches, and over the prior 3 to 4 months, her headache frequency had gradually increased. At the time of initial evaluation, she reported 30 headache days within the prior month, with 2 incapacitating days. Her neurologic examination was normal, and the impression was “transformed” migraine with and without aura. Oral topiramate 25 mg twice a day for 7 days was prescribed, with subsequent escalation to a target dose of 50 mg twice a day. Four days after increasing her dose to 50 mg twice daily she awoke with severe “blurry” vision and bilateral retrobulbar pain which was exacerbated by eye movements. Topiramate was stopped 2 days later. Neurologic evaluation 3 days following the onset of these symptoms was notable for Jaeger 1+ acuity, right eye and Jaeger 1 acuity, left eye with a near-card; she achieved Jaeger 1+ acuity, left eye with a pinhole. Examination was otherwise unremarkable. An ophthalmologic evaluation 1 day later was notable for distance visual acuity of 20 / 300, both eyes with correction by pinhole to 20 / 70. An Ansler grid, threshold visual field, and dilated examination were normal. Within 3 days of stopping topiramate, the patient reported improvement in her distance vision, and 6 days after stopping the drug, her vision was normal. To our knowledge, this is the third reported case of acute myopia induced by topiramate, and the first in a patient receiving topiramate for headache prophylaxis. Perhaps topiramate-related myopia results from the drug's inhibition of carbonic anhydrase activity.