{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T13:49:20Z","timestamp":1782481760851,"version":"3.54.5"},"reference-count":7,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,6,13]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>A woman in her 30s presented with sudden bilateral vision loss, ocular pain, headache, nausea and vomiting. She had been taking topiramate for migraine prophylaxis for 10 days. Examination revealed shallow anterior chambers and intraocular pressure (IOP) of 59\u2009mm Hg OD and 55\u2009mm Hg OS, with appositional angle closure. Anterior segment optical coherence tomography confirmed closed angles and ultrasound biomicroscopy revealed ciliary body effusion. A diagnosis of topiramate-induced acute angle closure was made. Prompt treatment with systemic and topical steroids, cycloplegics, mannitol and topical anti-glaucoma drugs led to rapid improvement in vision and IOP within 6\u2009hours. Full recovery was achieved by day 3. Acetazolamide triggered a recurrence of elevated IOP. This case highlights the importance of early initiation of systemic steroids, which can result in rapid anatomical and functional recovery, and underscores the potential for acetazolamide to worsen angle closure in such cases.<\/jats:p>","DOI":"10.1136\/bcr-2025-270143","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T13:10:55Z","timestamp":1782479455000},"page":"e270143","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Topiramate\u2019s ocular trap: acute angle closure rescued by early systemic steroid therapy"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4862-3635","authenticated-orcid":false,"given":"Mehak","family":"Gupta","sequence":"first","affiliation":[{"name":"Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arshi","family":"Singh","sequence":"additional","affiliation":[{"name":"Guru Nanak Eye Centre, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirti","family":"Singh","sequence":"additional","affiliation":[{"name":"Guru Nanak Eye Centre, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4061-4608","authenticated-orcid":false,"given":"Sunila","family":"Jain","sequence":"additional","affiliation":[{"name":"Ophthalmology, Royal Preston Hospital, Preston, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"2026062606101244000_19.6.e270143.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2003.04.004"},{"key":"2026062606101244000_19.6.e270143.2","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.1001\/archopht.119.11.1721","article-title":"Bilateral angle-closure glaucoma and ciliary body swelling from topiramate","volume":"119","author":"Rhee","year":"2001","journal-title":"Arch Ophthalmol"},{"key":"2026062606101244000_19.6.e270143.3","first-page":"588","article-title":"Topiramate-induced angle closure glaucoma: a review","volume":"100","author":"Bhattacharyya","year":"2017","journal-title":"Clin Exp Optom"},{"key":"2026062606101244000_19.6.e270143.4","first-page":"1080","article-title":"Clinical profile and management outcomes of topiramate-induced angle closure","volume":"100","author":"Senthil","year":"2016","journal-title":"Br J Ophthalmol"},{"key":"2026062606101244000_19.6.e270143.5","first-page":"S138","article-title":"Acute bilateral angle closure from topiramate","volume":"88","author":"Preechawat","year":"2005","journal-title":"J Med Assoc Thai"},{"key":"2026062606101244000_19.6.e270143.6","first-page":"31","article-title":"Drug-induced secondary angle closure glaucoma","volume":"3","author":"Mandal","year":"2009","journal-title":"J Curr Glaucoma Pract"},{"key":"2026062606101244000_19.6.e270143.7","doi-asserted-by":"crossref","first-page":"104","DOI":"10.5005\/jp-journals-10078-1261","article-title":"Drug-induced Acute Angle-closure Glaucoma: A Review","volume":"13","author":"Yang","year":"2019","journal-title":"J Curr Glaucoma Pract"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-270143","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T13:11:01Z","timestamp":1782479461000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-270143"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":7,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,26]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1136\/bcr-2025-270143"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-270143","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]}}}