Which ED medication is associated with angle-closure glaucoma via ciliochoroidal effusion?

• A. Phenelzine (Nardil)
• B. Tamoxifen (Nolvadex)
• C. Topiramate (Topamax)
• D. Metformin (Glucophage)

Answer: (C)

Topiramate can trigger a secondary angle-closure glaucoma through ciliochoroidal effusion. The drug can cause fluid buildup in the choroid and ciliary body, pushing the iris-lens diaphragm forward. This anterior displacement narrows or closes the angle, raising intraocular pressure and producing an acute glaucoma picture.

Patients often develop symptoms within days to weeks of starting the medication, with eye pain, redness, halos, and blurred vision. On examination, you may see a shallower anterior chamber and elevated IOP. The correct management is to discontinue topiramate immediately and initiate IOP-lowering therapy (such as a topical beta-blocker and/or alpha-agonist, and systemic acetazolamide if needed), with ophthalmology follow-up. Cycloplegics can help by pulling the iris-lens diaphragm posterior as the effusion resolves. The other listed medications do not cause this ciliochoroidal effusion–related angle-closure mechanism.