Acute Myopic Shift after a Single Dose of Acetazolamide: A Case Report and Review of the Literature

Abstract

We report the case of a 32-year-old male who presented with an acute myopic shift as a result of uveal effusion following a single administration of 250 mg acetazolamide. The drug was discontinued and following cycloplegia and topical steroid therapy, we observed progressive deepening of the anterior chamber, reopening of the iridocorneal angle, and complete resolution of the myopic shift after 5 days. A literature review since 1956 identified 23 cases, including ours, which developed a myopic shift after a median time of 24 h (3 – 24) following a median dose of 500 mg (125 – 1000) acetazolamide, with about a third complicated by angle closure ocular hypertension. This presumed idiosyncratic reaction can occur without prior drug exposure and independent of the phakic status. Treatment options include systematic drug withdrawal associated with cycloplegia, anti-glaucomatous agents, and/or corticosteroids. Full recovery is achieved within about 5 days (2 – 14). Given the widespread use of acetazolamide, awareness of this idiosyncratic reaction is crucial to avoid complications of acute angle-closure glaucoma.

Zusammenfassung

Wir schildern den Fall eines 32-jährigen Mannes, der nach der Einnahme von 250 mg Acetazolamid eine akute Myopisierung aufgrund einer Uvealeffusion entwickelte. Nach dem Absetzen des Medikaments und unter Anwendung von Zykloplegie und topischer Steroidtherapie konnten wir nach 5 Tagen eine fortschreitende Vertiefung der Vorderkammer, die Wiedereröffnung des iridokornealen Winkels und die vollständige Auflösung der Myopisierung beobachten. Eine Literaturrecherche seit 1956 identifizierte 23 Fälle, einschl. unseres eigenen, in denen eine Myopisierung nach einer medianen Zeit von 24 h (3 – 24) nach einer medianen Dosis von 500 mg (125 – 1000) durch Acetazolamid auftrat. Etwa ein Drittel wurde durch einen Winkelblock mit okulärer Hypertonie kompliziert. Diese vermutlich idiosynkratische Reaktion kann ohne vorherige Medikamenteneinnahme und unabhängig vom Linsenstatus auftreten. Behandlungsoptionen umfassen systematisches Absetzen des Medikaments in Verbindung mit Zykloplegie, antiglaukomatösen Medikamenten und/oder Kortikosteroiden. Eine vollständige Auflösung tritt in etwa 5 Tagen ein (2 – 14). Aufgrund der weit verbreiteten Anwendung von Acetazolamid ist das Wissen über diese idiosynkratische Reaktion entscheidend, um Komplikationen eines Winkelblockglaukoms zu vermeiden.

Keywords

acetazolamide - uveal effusion - angle closure - myopic shift - idiosyncratic drug reaction - UBM

Schlüsselwörter

Ultraschallbiomikroskopie (UBM) - Myopisierung - Acetazolamid - Uvealeffusion

Publication History

Received: 28 October 2023

Accepted: 11 December 2023

Article published online:
23 April 2024

• References

• 1 Back M. Transient myopia after use of acetazolamide (diamox). Arch Ophthalmol 1956; 55: 546-547
• 2 Hassan A. Episodic Ataxias: Primary and Secondary Etiologies, Treatment, and Classification Approaches. Tremor Other Hyperkinet Mov (N Y) 2023; 13: 9
• 3 Viet Tran H, Ravinet E, Schnyder C. et al. Blood-brain barrier disruption associated with topiramate-induced angle-closure glaucoma of acute onset. Klin Monbl Augenheilkd 2006; 223: 425-427
• 4 Roh YR, Woo SJ, Park KH. Acute-onset bilateral myopia and ciliochoroidal effusion induced by hydrochlorothiazide. Korean J Ophthalmol 2011; 25: 214-217
• 5 Kronning E. Transient myopia following the use of acetazolamide. Acta Ophthalmol (Copenh) 2009; 35: 478-484
• 6 Binder SS, Steele W. Acute transient myopia associated with use of acetazolamide (diamox). J Am Med Assoc 1957; 165: 154-155
• 7 Muirhead JF, Scheie HG. Transient myopia after acetazolamide. Arch Ophthalmol 1960; 63: 315-318
• 8 Halpern AE, Kulvin MM. Transient myopia during treatment with carbonic anhydrase inhibitors. Am J Ophthalmol 1959; 48: 534-535
• 9 Galin MA, Baras I, Zweifach P. Diamox-induced myopia. Am J Ophthalmol 1962; 54: 237-240
• 10 Garland MA, Sholk A, Guenter KE. Acetazolamide-induced myopia. Am J Obstet Gynecol 1962; 84: 69-71
• 11 Fan JT, Johnson DH, Burk RR. Transient myopia, angle-closure glaucoma, and choroidal detachment after oral acetazolamide. Am J Ophthalmol 1993; 115: 813-814
• 12 Parthasarathi S, Myint K, Singh G. et al. Bilateral acetazolamide-induced choroidal effusion following cataract surgery. Eye (Lond) 2007; 21: 870-872
• 13 Bayer A, Moroi SE. Acetazolamide and Bilateral Uveal Effusion With Secondary Acute Angle-Closure. Glaucoma Today 2010; 8: 50-52
• 14 Malagola R, Arrico L, Giannotti R. et al. Acetazolamide-induced cilio-choroidal effusion after cataract surgery: unusual posterior involvement. Drug Des Devel Ther 2013; 7: 33-36
• 15 de Rojas V, González-López F, Baviera J. Acetazolamide-induced bilateral choroidal effusion following insertion of a phakic implantable collamer lens. J Refract Surg 2013; 29: 570-572
• 16 Man X, Costa R, Ayres BM. et al. Acetazolamide-induced bilateral ciliochoroidal effusion syndrome in plateau iris configuration. Am J Ophthalmol Case Rep 2016; 3: 14-17
• 17 Llovet-Rausell A, Ruiz Tolosa F, Kudsieh B. Severe ocular side effects with acetazolamide: case report. Arch Soc Esp Oftalmol 2016; 91: 543-546
• 18 Hill AD. Myopic Changes in a Climber after Taking Acetazolamide and the Use of Corrective Lenses to Temporize Symptoms: A Case Report from Mount Kilimanjaro. Wilderness Environ Med 2016; 27: 397-400
• 19 Grigera JD, Grigera ED. Ultrasound biomicroscopy in acetazolamide-induced myopic shift with appositional angle closure. Arq Bras Oftalmol 2017; 80: 327-329
• 20 Kalina PH, Kalina AG. Bilateral transient myopia induced by oral acetazolamide in the early postoperative period after phacoemulsification. JCRS Online Case Reports 2020; 8: e00016
• 21 Anwar M, Brockmann T, Walckling M. et al. Acute angle-closure glaucoma and effusion syndrome after phacoemulsification. Ophthalmologe 2021; 118: 838-841
• 22 Rothwell A, Anderson O. Bilateral choroidal effusions after taking acetazolamide for altitude sickness. BMJ Case Rep 2022; 15: 5-8
• 23 Musetti D, Nicolò M, Bagnis A. et al. Bilateral choroidal detachment and myopic shift after acetazolamide intake for laser capsulotomy. Eur J Ophthalmol 2022; 32: NP51-NP53