Which medication is associated with mydriasis, cycloplegia, and increased intraocular pressure?

Which medication is associated with mydriasis, cycloplegia, and increased intraocular pressure?

• A. Metformin (Glucophage)
• B. Tamoxifen (Nolvadex)
• C. Ritalin, Dexedrine (ADHD)
• D. Topiramate (Topamax)

Answer: (D)

Medications can trigger secondary angle-closure glaucoma by altering the eye’s anatomy, causing the iris-lens diaphragm to shift forward and the anterior chamber to shallow, which blocks drainage and raises intraocular pressure. Topiramate is a classic offender because it can cause ciliochoroidal effusion that pushes the iris-lens apparatus forward. This creates an acute angle-closure situation that often presents with sudden eye pain, blurred vision, halos, and a dilated pupil, and it can be accompanied by a loss of accommodation (cycloplegia) during the attack. Since the drug is the trigger, stopping topiramate and treating the elevated IOP promptly are essential, with urgent ophthalmology input. Other listed medications do not have this well-established association with acute, drug-induced angle-closure glaucoma.

Medications can trigger secondary angle-closure glaucoma by altering the eye’s anatomy, causing the iris-lens diaphragm to shift forward and the anterior chamber to shallow, which blocks drainage and raises intraocular pressure. Topiramate is a classic offender because it can cause ciliochoroidal effusion that pushes the iris-lens apparatus forward. This creates an acute angle-closure situation that often presents with sudden eye pain, blurred vision, halos, and a dilated pupil, and it can be accompanied by a loss of accommodation (cycloplegia) during the attack. Since the drug is the trigger, stopping topiramate and treating the elevated IOP promptly are essential, with urgent ophthalmology input. Other listed medications do not have this well-established association with acute, drug-induced angle-closure glaucoma.