Korean J Ophthalmol.  2011 Jun;25(3):214-217. 10.3341/kjo.2011.25.3.214.

Acute-Onset Bilateral Myopia and Ciliochoroidal Effusion Induced by Hydrochlorothiazide

• Roh YR
• Woo SJ
• Park KH

• KMID: 1010032
• DOI: http://doi.org/10.3341/kjo.2011.25.3.214

Abstract

The authors experienced two cases of hydrochlorothiazide (HCTZ)-induced acute-onset bilateral myopia and shallowing of the anterior chambers. Two middle-aged women taking HCTZ, a sulfa derivative, visited our clinic complaining of acute bilateral visual deterioration. Both had good visual acuity without corrective lenses before taking HCTZ. A complete ophthalmologic examination revealed bilateral myopic shift, intraocular pressure elevation, shallowing of the anterior chambers, choroidal effusions, radiating retinal folds, and conjunctival chemosis. Approximately one week after HCTZ discontinuance, all ocular changes disappeared completely. Physicians should be aware of the adverse ocular effects of HCTZ and should manage patients accordingly.

Keyword

Angle closure; Ciliochoroidal effusion; Drug-induced myopia; Hydrochlorothiazide; Myopia

MeSH Terms

Acute Disease
Adult
Anterior Chamber/drug effects
Choroid/drug effects/*metabolism
Cilia/drug effects/*metabolism
Diuretics/*adverse effects
Exudates and Transudates/*metabolism
Female
Humans
Hydrochlorothiazide/*adverse effects
Intraocular Pressure/drug effects
Middle Aged
Myopia/*chemically induced

Figure

• 

  Fig. 1 Ocular features at initial presentation (case 1). Anterior segment photographs of right (A) and left (B) eyes showing conjunctival chemosis and injection. (C) A fundus photograph of the right eye showing thin radiating retinal folds around the macula. (D) A photograph of the peripheral retina of the left eye showing ora serrata and an atrophic retinal hole (white arrow). The visibility of the ora serrata indicates choroidal effusion.

• 

  Fig. 2 Ocular features after the cessation of hydrochlorothiazide (case 1). Anterior segment photographs of the right (A) and left (B) eyes revealing no conjunctival chemosis. (C) A fundus photograph of the right eye showing a normal macular appearance. (D) The ora serrata is no longer visible in this photograph of the peripheral retina of the left eye, but it can be inferred by the barrier laser markings around the atrophic hole.

Reference

1. Sankar PS, Pasquale LR, Grosskreutz CL. Uveal effusion and secondary angle-closure glaucoma associated with topiramate use. Arch Ophthalmol. 2001. 119:1210–1211.

2. Guier CP. Elevated intraocular pressure and myopic shift linked to topiramate use. Optom Vis Sci. 2007. 84:1070–1073.

3. Li J, Tripathi RC, Tripathi BJ. Drug-induced ocular disorders. Drug Saf. 2008. 31:127–141.

4. Beermann B, Groschinsky-Grind M, Rosen A. Absorption, metabolism, and excretion of hydrochlorothiazide. Clin Pharmacol Ther. 1976. 19(5 Pt 1):531–537.

5. Geanon JD, Perkins TW. Bilateral acute angle-closure glaucoma associated with drug sensitivity to hydrochlorothiazide. Arch Ophthalmol. 1995. 113:1231–1232.

6. Boentert M, Aretz H, Ludemann P. Acute myopia and angle-closure glaucoma induced by topiramate. Neurology. 2003. 61:1306.

7. Rhee DJ, Goldberg MJ, Parrish RK. Bilateral angle-closure glaucoma and ciliary body swelling from topiramate. Arch Ophthalmol. 2001. 119:1721–1723.

8. Craig JE, Ong TJ, Louis DL, Wells JM. Mechanism of topiramate-induced acute-onset myopia and angle closure glaucoma. Am J Ophthalmol. 2004. 137:193–195.

9. Fraunfelder FW, Fraunfelder FT, Keates EU. Topiramate-associated acute, bilateral, secondary angle-closure glaucoma. Ophthalmology. 2004. 111:109–111.

10. Kerimoglu H, Tokgoz M, Ozturk B, et al. Topiramate-induced acute-onset myopia and central corneal thickening: Pentacam Scheimpflug imaging findings. Can J Ophthalmol. 2009. 44:222–223.

11. Krieg PH, Schipper I. Drug-induced ciliary body oedema: a new theory. Eye (Lond). 1996. 10(Pt 1):121–126.

12. Desai CM, Ramchandani SJ, Bhopale SG, Ramchandani SS. Acute myopia and angle closure caused by topiramate, a drug used for prophylaxis of migraine. Indian J Ophthalmol. 2006. 54:195–197.