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

 

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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.

Publication History

Received: 28 October 2023

Accepted: 11 December 2023

Article published online:
23 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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