Glaucoma: topiramate-induced angle closure: practice question

A Ophthalmology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Ophthalmology · Glaucoma: topiramate-induced angle closure

Sample item

A woman started on a migraine prophylactic two weeks ago presents with bilateral blurred vision, new myopia of about 5 dioptres, shallow anterior chambers and raised intraocular pressure. The angles are closed but there is no pupillary block. What is the most appropriate management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Stop the drug and start a cycloplegic with aqueous suppressants

Topiramate can cause ciliochoroidal effusion that rotates the ciliary body forward, giving bilateral myopic shift, shallow chambers and angle closure without pupillary block. Treatment is to stop the drug, give cycloplegics and aqueous suppressants, and avoid miotics, which worsen the forward rotation.

Option by option

  • A. Topical pilocarpine to open the angle

    Pilocarpine contracts the ciliary muscle, rotating the ciliary body forward and aggravating the closure.

  • B. Urgent trabeculectomy in both eyes

    Trabeculectomy is a last resort and is not needed when the cause is reversible.

  • C. Stop the drug and start a cycloplegic with aqueous suppressants (correct)

    Correct. Withdrawal of the culprit, cycloplegia and pressure-lowering drops treat this effusion-related closure.

  • D. Laser peripheral iridotomy in both eyes

    Iridotomy relieves pupillary block, which is absent here, so it does not help.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Ophthalmology question

What is the answer to this Ophthalmology question?

The best answer is C, Stop the drug and start a cycloplegic with aqueous suppressants. Topiramate can cause ciliochoroidal effusion that rotates the ciliary body forward, giving bilateral myopic shift, shallow chambers and angle closure without pupillary block.

Why is "Topical pilocarpine to open the angle" not the answer?

Pilocarpine contracts the ciliary muscle, rotating the ciliary body forward and aggravating the closure.

Why is "Urgent trabeculectomy in both eyes" not the answer?

Trabeculectomy is a last resort and is not needed when the cause is reversible.

Why is "Laser peripheral iridotomy in both eyes" not the answer?

Iridotomy relieves pupillary block, which is absent here, so it does not help.

What concept does this question test?

It tests Glaucoma: topiramate-induced angle closure in Ophthalmology. Treatment is to stop the drug, give cycloplegics and aqueous suppressants, and avoid miotics, which worsen the forward rotation.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Glaucoma: topiramate-induced angle closure?

Group the red eye by what to examine and what the pupil does. Then use the flashcards and the other Ophthalmology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.