Acanthamoeba Keratitis ; diagnosis ; drug therapy ; Anti-Inflammatory Agents, Non-Steroidal ; administration & dosage ; Atropine ; administration & dosage ; Cornea ; pathology ; Diagnosis, Differential ; Diclofenac ; administration & dosage ; Drug Administration Schedule ; Drug Therapy, Combination ; Follow-Up Studies ; Humans ; Mydriatics ; administration & dosage ; Ophthalmic Solutions ; Retrospective Studies

PURPOSE: To report a case involving an unexpected increase in intraocular pressure (IOP) and acute angle closure after oral administration of methazolamide. CASE SUMMARY: A 38-year-old male visited the emergency department complaining of decreased visual acuity (VA) and ocular pain. These symptoms developed after he took two tablets of 50 mg methazolamide because his IOP was above normal after a short course of systemic steroid treatment. His uncorrected VA dropped to 0.04 and the refractive error was −6.5 diopters in both eyes. The anterior chamber was very shallow, and the IOPs were 46 mmHg in the right eye and 42 mmHg in the left eye. Macular retinal folds were observed in both eyes in infrared fundus images. The patient was instructed not to take methazolamide, which was suspected as the cause of this idiosyncratic drug reaction. He was prescribed topical anti-glaucoma medications and cycloplegics to relieve the acute angle closure, and all symptoms disappeared after these treatments. CONCLUSIONS: Methazolamide is a sulfa derivative like topiramate, which can cause acute angle closure involving edema of the ciliary body and anterior displacement of the lens-iris diaphragm. Clinicians should consider this possible IOP increase before prescribing methazolamide.
Administration, Oral ; Adult ; Anterior Chamber ; Ciliary Body ; Diaphragm ; Edema ; Emergency Service, Hospital ; Humans ; Intraocular Pressure* ; Male ; Methazolamide* ; Mydriatics ; Refractive Errors ; Retinaldehyde ; Tablets ; Visual Acuity

PURPOSE: To maximize effective use of mydriatic drugs through comparing the pupillary dilation effects between 1% tropicamide and 2.5% phenylephrine. METHODS: Fifty people requiring pupillary dilation were divided into 3 groups. Group 1 was treated with one drop of 1% tropicamide in the right eye and one drop of 2.5% phenylephrine in the left eye. Group 2 was treated twice during a 5-minute interval with 1% tropicamide in the right eye. Group 3 was treated twice during a 5-minute interval with 2.5% phenylephrine in the right eye. Groups 2 and 3 were treated with 2.5% phenylephrine and 1% tropicamide in the left eye, administered during a 5-minute interval. The pupillary size was measured in all groups for 40 minutes following eye drops administration. RESULTS: The mean patient age was 15.7 years. Group 1 included 10 patients, and groups 2 and 3 included 20 patients each. Eight patients in group 1 and 16 patients in group 2 developed a larger right pupil. Fourteen patients in group 3 developed a larger left pupil. CONCLUSIONS: Our study showed that 1% tropicamide, with its parasympathetic antagonistic mechanism of action, was more effective at inducing pupillary dilation than 2.5% phenylephrine, and the combination of 1% tropicamide and 2.5% phenylephrine was more effective than multiple drops of single eye drops.
Adolescent ; Adult ; Child ; Child, Preschool ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Female ; Follow-Up Studies ; Humans ; Male ; Muscarinic Antagonists/*administration & dosage ; Mydriatics/*administration & dosage ; Ophthalmic Solutions ; Phenylephrine/*administration & dosage ; Pupil/*drug effects ; Refractive Errors/diagnosis/physiopathology ; Retrospective Studies ; Tropicamide/*administration & dosage ; Young Adult