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Drug induced acute myopia with supraciliary choroidal effusion in a patient with Wegener's granulomatosis
  1. J C Ramos-Esteban,
  2. S Goldberg,
  3. J Danias
  1. Department of Ophthalmology, Mount Sinai School of Medicine, One Gustave L Levy Place, Box 1183, New York, NY 10029-6574, USA
  1. Correspondence to: John Danias, MD, PhD; john.danias{at}mssm.edu

https://doi.org/10.1136/bjo.86.5.594-a

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    Acute transient myopia with shallowing of the anterior chamber is a rare idiosyncratic response to systemic and topical use of many medications1 including sulphonamides.2 Although many such cases have been reported in the past, they have been relatively rare in recent years. A-scan ultrasonography has been used to measure anterior chamber depth and lens thickness during the myopic phase.3 Ultrasound biomicroscopic (UBM) imaging during the acute phase has only been reported twice.4,5 We present a case of drug induced bilateral transient myopia with shallow anterior chambers, where UBM aided in the diagnosis and provided clues to the mechanism responsible for this reaction.

    Case report

    A 39 year old white woman complained of acute onset of blurry vision and decreased visual acuity at distance starting on the morning of the day she presented to her primary ophthalmologist. On examination by the primary ophthalmologist the patient was found to have a myopic shift of 7.00 dioptres in both eyes and was noted to have narrow angles. She was referred the same day to JD for treatment of bilateral angle closure.

    Her medical history was significant for Wegener's granulomatosis diagnosed 1 year earlier and confirmed with a renal biopsy. She had been treated with Cytoxan and prednisone, despite which renal failure ensued. Approximately 4 months before presentation the patient had begun haemodialysis and 1 month before presentation she was started on peritoneal dialysis. The patient was maintained on a regimen of immunosuppressives, which included Cytoxan and prednisone. Twelve hours before presentation, she had received the first dose of Bactrim (160 mg trimethoprim and 800 mg sulphamethoxazole) as prophylaxis for Pneumocystis carinii.

    Her examination was significant for mild dehydration. The patient had recently noted a negative fluid balance on peritoneal dialysis. The patient had a negative family history for glaucoma …

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