Hussain Ahsan, Snyder Kiersten, Paroya Shahnawaz, Mahesh Sankara
Ophthalmology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA.
Ophthalmology, New York Medical College, Valhalla, USA.
Cureus. 2023 Mar 22;15(3):e36529. doi: 10.7759/cureus.36529. eCollection 2023 Mar.
A 51-year-old female was referred to the emergency department with a one-day history of severe right eye pain, blurry vision, and conjunctival injection. A review of past ocular history was notable for nanophthalmos and narrow angles with patent peripheral iridotomies. Anterior segment exam findings were consistent with aqueous misdirection and a review of medications indicated recent topiramate initiation for headaches and depression. The acute attack was initially controlled with medical management and plans for future surgical intervention were made. Although ocular screening prior to initiation of topiramate is not recommended, this case highlights the importance of pre-screening in a patient with a pre-existing condition such as nanophthalmos. Additionally, this case addresses the ocular side effects of anti-depressants and the emerging relationship between glaucoma and depression. Appropriately addressing these issues and coordinating care with behavioral health providers has the potential to prevent optic nerve damage and loss of vision.
一名51岁女性因右眼剧痛、视力模糊和结膜充血1天被转诊至急诊科。既往眼部病史显示有小眼球和窄房角，周边虹膜切开术通畅。前段检查结果与房水错流一致，药物审查表明近期开始使用托吡酯治疗头痛和抑郁症。急性发作最初通过药物治疗得到控制，并制定了未来手术干预计划。虽然不建议在开始使用托吡酯之前进行眼部筛查，但该病例突出了对患有小眼球等既往疾病的患者进行预筛查的重要性。此外，该病例还涉及抗抑郁药的眼部副作用以及青光眼与抑郁症之间新出现的关系。适当地解决这些问题并与行为健康提供者协调护理有可能预防视神经损伤和视力丧失。
