title: Severe ocular side effects with acetazolamide: case report.
abstract: METHODS
  A 44-year-old woman arrived in the emergency department complaining of decreased visual acuity (VA) in oculus uterque (OU) of 4hours onset. Signs of myopia, increased intraocular pressure (IOP) in OU, and a narrow grade II anterior chamber (AC) were observed. In the posterior segment ultrasound scan, a choroidal peripheral detachment is evident, and a lenticular thickness of 4.05mm is measured in the anterior segment of the right eye (OD) and 4.00mm in the left eye (OS). On treatment with oral with naproxen (non-steroidal anti-inflammatory drug), and acetazolamide for migraine. The acetazolamide is suspended and topical treatment is started with timolol and brimonidine every 12hours, with prednisolone and ayclopentolate every 8hours. In the follow-up, a gradual reduction of myopia and lens thickness is observed, as well as anterior chamber expansion. In the last control, the patient had a sphere of -0.75 diopters (D) in OD and -0.25 D in OS. IOP was 15mmHg in OU and AC was grade III. The ultrasound showed a lens thickness of 3.59mm in OD and 3.61mm in OS.
  
  
  CONCLUSIONS
  This was an iatrogenic case of acute angle closure induced by an anterior displacement of the irido-lenticular complex, secondary to the use of acetazolamide. The treatment of this condition involves suspending the drug responsible and applying topical corticosteroids, hypotensive and cycloplegic eye drops, with the aim of lowering the eye pressure and the degree of myopia due to the re-positioning of the irido-lenticular complex.
authors.affiliation: Instituto Universitario Barraquer, Universidad Autónoma de Barcelona, Barcelona, España. Electronic address: andrea.llovet@barraquer.com.
authors.forename: A
authors.initials: A
authors.lastname: Llovet-Rausell
authors.affiliation: Instituto Universitario Barraquer, Universidad Autónoma de Barcelona, Barcelona, España.
authors.forename: F
authors.initials: F
authors.lastname: Ruiz Tolosa
authors.affiliation: Instituto Universitario Barraquer, Universidad Autónoma de Barcelona, Barcelona, España.
authors.forename: B
authors.initials: B
authors.lastname: Kudsieh
mesh_terms: D000086:Acetazolamide / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D000208:Acute Disease; D000328:Adult; D000068438:Brimonidine Tartrate / Q000627:therapeutic use; D003519:Cyclopentolate / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000139:chemically induced* / Q000188:drug therapy; D006801:Humans; D007498:Iris / Q000187:drug effects; D007908:Lens, Crystalline / Q000187:drug effects; D008881:Migraine Disorders / Q000188:drug therapy; D011239:Prednisolone / Q000627:therapeutic use*; D013999:Timolol / Q000627:therapeutic use
chemical_list: D000068438:Brimonidine Tartrate; D013999:Timolol; D011239:Prednisolone; D003519:Cyclopentolate; D000086:Acetazolamide
keywords: Acetazolamida; Acetazolamide; Acute cilio-choroidal effusion; Angle-closure; Cierre angular; Efusión cilio-coroidea; Iatrogenesis; Iatrogenia; Miopización; Myopisation