Which medication is associated with myopia and secondary angle-closure glaucoma?

• A. Estrogen agonists (oral contraceptives)
• B. Ritalin, Dexedrine (ADHD)
• C. Topiramate (Topamax)
• D. Tamoxifen (Nolvadex)

Answer: (C)

Topiramate can cause acute myopia with secondary angle-closure glaucoma through ciliochoroidal effusion that pushes the iris-lens diaphragm forward. This forward shift shallows the anterior chamber and narrows the angle, leading to a rapid rise in intraocular pressure. It often occurs within days to weeks after starting the medication and can be bilateral. This mechanism is different from pupillary-block glaucoma, so pilocarpine may not help and can worsen the situation; the key treatment is stopping topiramate and lowering IOP with appropriate medications, plus strategies to move the iris-lens diaphragm back (such as cycloplegics) and sometimes a short course of steroids to reduce edema. The other listed drugs aren’t typically associated with this characteristic pattern of myopia plus angle-closure glaucoma.