Which anticonvulsant is known to cause acute angle-closure glaucoma?

Which anticonvulsant is known to cause acute angle-closure glaucoma?

• A. Topiramate
• B. Lamotrigine
• C. Levetiracetam
• D. Gabapentin

Answer: (A)

Drug-induced acute angle-closure glaucoma happens when a medication alters the eye’s anatomy, causing the iris-lens diaphragm to move forward and the drainage angle to narrow or close. Topiramate is strongly linked to this condition because it can cause ciliochoroidal effusion, which pushes the iris forward and deepens the anterior chamber in a way that blocks outflow, leading to a rapid rise in intraocular pressure. This usually appears within days to weeks after starting or increasing the dose. The other anticonvulsants mentioned do not have this mechanism or the same risk, so they are not typically associated with this emergency. If suspected, discontinue the drug and seek urgent eye care to lower the pressure and address the structural change.

Drug-induced acute angle-closure glaucoma happens when a medication alters the eye’s anatomy, causing the iris-lens diaphragm to move forward and the drainage angle to narrow or close. Topiramate is strongly linked to this condition because it can cause ciliochoroidal effusion, which pushes the iris forward and deepens the anterior chamber in a way that blocks outflow, leading to a rapid rise in intraocular pressure. This usually appears within days to weeks after starting or increasing the dose. The other anticonvulsants mentioned do not have this mechanism or the same risk, so they are not typically associated with this emergency. If suspected, discontinue the drug and seek urgent eye care to lower the pressure and address the structural change.