Topiramate for the treatment of chronic corneal pain.
OBJECTIVE
To explore the option of using anticonvulsant drugs to modulate pain from corneal erosions.


METHODS
N.M. is a 28-year-old woman with posttraumatic recurrent corneal erosions treated with bandage contact lenses, Muro-128, topical ketorolac, doxycycline, stromal micropuncture, and laser epithelial keratomileusis over the course of 4 years. Because of persistent episodes of corneal pain, she was prescribed topiramate.


RESULTS
Before starting topiramate therapy, N.M. had experienced 3-4 awakenings at night because of pain and 5-6 episodes of spontaneous tearing and pain during the day. She started topiramate at 25 mg orally 4 times a day without significant change in her symptoms. After 1 week, the dose was escalated to 50 mg orally 4 times a day, and within 1 day, she experienced 0-1 awakenings at night. She had approximately 2-3 episodes of pain and tearing during the day. The dose was escalated to 100 mg orally 4 times a day. At that dose, the patient continued to have pain relief but complained of nausea. The patient's topiramate was weaned off to determine whether her symptom relief was caused by the medication or improvement in her condition. Once off the topiramate, N.M.'s nausea resolved but her corneal symptoms returned at the same frequency as before the initiation of topiramate. Therefore, she was restarted on topiramate 50 mg orally 4 times a day with rapid onset of improvement in her symptoms.


CONCLUSIONS
Anticonvulsants such as topiramate may be effective in the management of pain caused by recurrent corneal erosions.
Nampiaparampil
Devi E
DE
Division of Pain Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. devichechi@gmail.com
Nampiaparampil
Robert G
RG
Prasad
Anita G
AG
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D002908:Chronic Disease; D003316:Corneal Diseases / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005632:Fructose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D000077236:Topiramate
D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose