Topiramate-Induced Bilateral Acute Angle Closure in a Healthy Young Female

Topiramate is a widely prescribed medication for epilepsy, migraine prophylaxis, and weight management, but it can rarely cause acute bilateral angle closure with myopic shift. We describe a healthy 35-year-old woman who developed sudden bilateral painful red eyes, blurred vision, and a myopic shift within one week of initiating topiramate. Examination revealed shallow anterior chambers, elevated intraocular pressure, and iridocorneal touch bilaterally. Prompt discontinuation of topiramate led to full resolution. Laser peripheral iridotomies (LPIs) were performed while the etiology was uncertain, and are not typically required in medication-induced effusion-related angle closure. This case underscores that cycloplegia and drug cessation are the key interventions, while LPI may be performed only when the underlying mechanism is unclear. This case highlights the importance of recognizing medication-induced angle closure and distinguishing it from primary pupillary-block mechanisms to ensure timely, vision-saving management.