TOPIRAMATE ASSOCIATED ACUTE ANGLE GLAUCOMA IN A PEDIATRIC PATIENT

Introduction/Objective: Topiramate is commonly prescribed for migraine prophylaxis with rare cases of acute angle glaucoma reported from its use. This case contributes to the literature one such case in a pediatric patient, and is presented to increase awareness. 16yo female with PMH of migraine presented to the ED for loss of vision over the preceding 18-24hrs and migraine with topiramate started 10d prior. The night before she had difficulty seeing across the room and noticed a headache. The day of admission she was limited to shadows and light and worsened headache. In the ED, Ophthalmology and Neurology found IOP of 30mm Hg bilaterally and migraine. Topiramate was discontinued. She was admitted for pain control and treatment of glaucoma with prednisolone, latanoprost, and timolol. During her admission her pain decreased to 4/10 and her IOP returned to normal. Methods: A chart review was performed after the patient was discharged. A Pubmed search of relevant keywords was used to find previously reports cases. Results/Conclusions: Topiramate is a widely used drug in adults, but has limited research in pediatrics. Acute glaucoma is well described in adults, but only one case reported in children at the time of this review. Our patient was similar to that report. Topiramate, previously only used off-label for migraine prophylaxis in pediatrics, received that indication from the FDA for ages 12-17 in 2014. With the possibility of increasing use in the pediatric population, it is imperative that family physicians recognize and quickly treat this adverse reaction.