Good afternoon everyone,

I hope those who are able to take some time off, have an enjoyable winter vacation.

This month’s topic is a case study of ‘drug-induced ocular side effects’.

A 12-year-old girl came into my clinic complaining of rapidly worsening vision in both eyes, diplopia with intermittent exotropia, and photosensitive eyes. The patient had a history of GLUT 1 deficiency syndrome, migraines, headaches, and an elevated BMI.

Her prior eye examination was reported normal. On day of examination, her uncorrected visual acuity was 6/38 in each eye and best corrected visual acuity was 6/7.5 in each eye with -3.50 DS. She had intermittent exotropia. Otherwise her ocular exam was unremarkable and had no signs of angle closure or evidence of disc swelling.

When she was questioned about her medications, it was discovered that a paediatrician had recently started her on Topiramate to treat her migraines, and she has subsequently noted deterioration in her vision with diplopia and exotropia. Her symptoms were deemed to be drug-induced by Topiramate, and she was recommended to discontinue the medication. A paediatric review has been recommended to consider alternative treatment option. Her sysmptoms are persistent but she undergoes regular short check-ups in our clinic to evaluate her recovery with the hope that symptoms will resolve over time.

The attached article discusses Topiramate’s ocular side effects including acute myopia, acute angle closure glaucoma, diplopia, blepharospasm, suprachoroidal effusions, peri-orbital edema, scleritis, oculogyric crisis, periocular pain, and nystagmus. The recommendations are also considerable as my patient was unaware of ocular side effects especially blurry vision and diplopia.

I’m looking forwards to hearing from the wider group about their clinical experiences, particularly if you’ve encountered similar circumstances, as we regularly see patients with background of epilepsy using Topiramate. How long did it take before symptoms resolved, and what therapeutic choices were available to treat ocular issues?

Review Article

My review article is from January 2020 submitted by Trish regarding “ophthalmic disorders and risk factors in children with ASD”.

It serves as a reminder to conduct necessary assessments, develop suitable referral pathways within our teams for timely diagnosis and appropriate management, and check progress on a regular basis.

Thanks,

Hamza