Page 12 - 21st Century Perspective - Glaucoma Supplement

Oral Topiramate

Topiramate (Topamax, Janssen) is a commonly used medication specifically indicated for seizure
disorders as well as for the prevention of migraine headaches ​(Figure 7)​. However, it is even more

commonly used off-label to help treat a variety of other conditions, including obesity, eating
disorders, bipolar disorder, obsessive-compulsive disorder, idiopathic intracranial hypertension,
neuropathic pain and other esoteric conditions. Topiramate is well known to be able to cause ciliary
body effusion, which is uncommon but results in anterior rotation of the iridolenticular diaphragm.
Such rotation induces myopia by moving the lens anteriorly, and increases IOP by (usually
incomplete) angle-closure. This iatrogenic event is bilateral because it is an idiosyncratic expression
of an orally administered drug.

Figure 7.​ Oral topiramate (Topamax).

Topiramate-induced myopia and ocular hypertension results from swelling (effusion) of the ciliary
body. Therefore, medical management is unique and distinctly different from that of typical anatomic
angle-closure. The first step is to stop the topiramate. If the patient is using the drug for seizure
control, then the prescribing neurologist (or if after office hours, then the on-call neurologist) needs to
be consulted. However, for other less critical uses such as for the prevention of migraine headache

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