Aug 09, 2008
I hope anyone who uses Topamax for any reason is fully aware of the serious risk of acute narrow angle glaucoma. I had read several articles about it but saw it firsthand last week. As usual on my quiet weekend off I got the dreaded call from the emergency room, again. This time about a woman on Topamax for 7 days who seemed to have lost almost all her vision 12 hours after increasing her dose per her doctor's instructions. Some quick thinking sparked me to ask if she could see up close and lo and behold while she was blind as a bat in the distance, she could see the tiniest print about 6 inches in front of her nose. She had developed an acute myopic shift from a choroidal effusion which pushed the lens/iris diaphram forward. Fortunately, God was on her side because she was smart enough to stop the Topamax and go to the emergency room before she developed an attack of acute narrow angle glaucoma (symptoms severe eye pain, headache, nausea, vomiting, almost complete vision loss.) Her ocular pressure was actually only slightly elevated and with cessation of the Topamax, her pressure returned to normal in a day, while it took over a week for her vison to return to normal. It was extremely impressive the way the lens moved forward initially. After a week, the lens moved back to normal position and the eye looked completely different as if from another person. It was really something I will never forget. She could have gone blind if she hadn't stopped the drug and gone to the emergency room.
So, if you are taking Topamax or getting ready to increase you dose or considering starting it - please, please take my advice and remember that it can cause sudden worsening of your vision, and if an attack of narrow angle glaucoma starts, you can develop severe eye pain, extreme headache, nausea, vomiting and nearly complete loss of vision.
Next on my list of least favorite drugs - Flomax - the only drug I know of that actually caused it's own completely new syndrome - the formidable "Floppy Iris Syndrome" nemesis of cataract surgeons everywhere.
Michael Kutryb, MD