J Korean Ophthalmol Soc.  2017 Dec;58(12):1420-1424. 10.3341/jkos.2017.58.12.1420.

Angle Closure and the Acute Rise of Intraocular Pressure after Administration of Methazolamide

• Jeong KD
• Kim B
• Oh WH

• KMID: 2397858
• DOI: http://doi.org/10.3341/jkos.2017.58.12.1420

Abstract

PURPOSE
To report a case involving an unexpected increase in intraocular pressure (IOP) and acute angle closure after oral administration of methazolamide.
CASE SUMMARY
A 38-year-old male visited the emergency department complaining of decreased visual acuity (VA) and ocular pain. These symptoms developed after he took two tablets of 50 mg methazolamide because his IOP was above normal after a short course of systemic steroid treatment. His uncorrected VA dropped to 0.04 and the refractive error was −6.5 diopters in both eyes. The anterior chamber was very shallow, and the IOPs were 46 mmHg in the right eye and 42 mmHg in the left eye. Macular retinal folds were observed in both eyes in infrared fundus images. The patient was instructed not to take methazolamide, which was suspected as the cause of this idiosyncratic drug reaction. He was prescribed topical anti-glaucoma medications and cycloplegics to relieve the acute angle closure, and all symptoms disappeared after these treatments.
CONCLUSIONS
Methazolamide is a sulfa derivative like topiramate, which can cause acute angle closure involving edema of the ciliary body and anterior displacement of the lens-iris diaphragm. Clinicians should consider this possible IOP increase before prescribing methazolamide.

Keyword

Acute angle closure; Cilioretinal effusion; Idiosyncratic drug reaction; Methazolamide; Sulfa-derivatives

MeSH Terms

Administration, Oral
Adult
Anterior Chamber
Ciliary Body
Diaphragm
Edema
Emergency Service, Hospital
Humans
Intraocular Pressure*
Male
Methazolamide*
Mydriatics
Refractive Errors
Retinaldehyde
Tablets
Visual Acuity
Methazolamide
Mydriatics
Retinaldehyde
Tablets

Figure

• 

  Figure 1 Scheimpflug images of AL-scan® (Nidek, Gamagori, Japan). (A) Shallow central anterior chamber at the initial presentation. (B) Deepening of central anterior chamber at the final visit. ACD = anterior chamber depth, distance between the anterior corneal surface to the anterior lens surface; CCT = central corneal thickness; OD = oculus dexter; OS = oculus sinister.

• 

  Figure 2 Anterior segment optical coherent tomography of temporal quadrant of drainage angle in the right eye. Peripheral crowding of angle was shown in (A) (2 days after acute angle closure). Drainage angle has been widened, but peripheral iris was still located more anteriorly than central iris (B) (4 days after acute angle closure).

• 

  Figure 3 Infrared (IR) images and optical coherent tomography (OCT) images. IR images (A, B, D, E) and OCT images of the right eye taken simultaneously with A and D (C, F). IR images showed that retinal folds at the initial presentation (A, B), and resolution of retinal folds at the final visit (D, E). OCT images showed that retinal folds were limited in the inner retinal layers (A), and resolved at the final visit (F).

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