Topiramate induced bilateral angle closure with anterior uveitis – A masquerade in a migraine patient

Topiramate (TPM), a sulphonamide derivative, is a commonly used medication by physicians and psychiatrists. Topiramate-induced angle closure glaucoma (ACG) and TPM-induced myopic shift are reported ocular adverse reactions of this drug. We report here a case of TPM-induced ciliochoroidal effusion presenting as bilateral acute angle closure with anterior uveitis and myopic shift in a patient with migraine. The acute and often bilateral severe visual deterioration in patients on TPM therapy cannot only be disturbing to the patient but can also be a challenge to the attending ophthalmologist to manage. We highlight the confusing presentation leading to the initial misdiagnosis of bilateral ACG and challenges in the management of this potentially sight-threatening condition.