2026 American Academy of Neurology Abstract Website

Objective:

NOT APPLICABLE

Background:

Topiramate, a sulfamate substituted monosaccharide widely used for migraine prophylaxis and weight reduction, has been increasingly associated with acute ocular complications. The most recognized is topiramate induced secondary angle closure glaucoma, mediated by ciliochoroidal effusion and forward lens displacement. However, cortical ocular injury characterized by transient visual loss, photophobia, and fundoscopic alterations remains an underreported phenomenon. We present a case illustrating the complex interaction between cortical and anterior segment pathology following short-term topiramate exposure.

Design/Methods:

A 14-young female was admitted to the emergency department after three days of progressive, severe frontoparietal headache (10/10), photophobia, constant tearing, and blurred vision. Neurological examination was unremarkable, but mild bilateral periorbital edema and intense epiphora were noted. She had initiated topiramate combined with metformin eight days earlier for weight loss. Ophthalmologic evaluation revealed elevated intraocular pressure with narrow angle behavior but minimal conjunctival hyperemia. Brain MRI demonstrated an extra-axial enhancing lesion suggestive of periosteal fibroma, without intracranial hypertension. Fundoscopic images revealed subtle cortical retinal changes. Laboratory results were within normal limits. Topiramate was discontinued immediately, and conservative treatment with systemic analgesia, hydration, and anxiolytic support was initiated.

Results:

Within 72 hours of drug cessation, intraocular pressure normalized and visual acuity progressively improved. Serial ophthalmologic follow-up demonstrated full recovery of visual fields and resolution of cortical retinal changes over subsequent weeks.

Conclusions:

This case highlights dual mechanisms of topiramate-induced ocular injury: ciliochoroidal effusion causing secondary angle narrowing, and possible cortical retinal involvement from altered vascular permeability or transient bloodVretina barrier disruption. Lack of pain or redness delayed recognition, emphasizing the need for clinical suspicion even in mild presentations. Topiramate can cause multifocal ocular damage beyond the anterior segment. Early recognition and prompt discontinuation are essential to prevent irreversible cortical retinal injury. Clinicians should remain vigilant when prescribing topiramate for off-label indications, particularly in young women.