I hope anyone who uses Topamax for any reason is fully aware of the serious risk of acute narrow angle glaucoma.  I had read several articles about it but saw it firsthand last week.  As usual on my quiet weekend off I got the dreaded call from the emergency room, again.  This time about a woman on Topamax for 7 days who seemed to have lost almost all her vision 12  hours after increasing her dose per her doctor's instructions.  Some quick thinking sparked me to ask if she could see up close and lo and behold while she was blind as a bat in the distance, she could see the tiniest print about 6 inches in front of her nose.  She had developed an acute myopic shift from a choroidal effusion which pushed the lens/iris diaphram forward.  Fortunately, God was on  her side because she was smart enough to stop the Topamax and go to the emergency room before she developed an attack of acute narrow angle glaucoma (symptoms severe eye pain, headache, nausea, vomiting, almost complete vision loss.)  Her ocular pressure was actually only slightly elevated and with cessation of the Topamax, her pressure returned to normal in a day, while it took over a week for her vison to return to normal.  It was extremely impressive the way the lens moved forward initially.  After a week, the lens moved back to normal position and the eye looked completely different as if from another person.  It was really something I will never forget.  She could have gone blind if she hadn't stopped the drug and gone to the  emergency room.

So, if you are taking Topamax or getting ready to increase you dose or considering starting it - please, please take my advice and remember that it can cause sudden worsening of your vision, and if an attack of narrow angle glaucoma starts, you can develop severe eye  pain, extreme headache, nausea, vomiting and nearly complete loss of vision.
Next on my list of least favorite drugs - Flomax - the only drug I know of that actually caused it's own completely new syndrome - the formidable "Floppy Iris Syndrome" nemesis of cataract surgeons everywhere.

Michael Kutryb, MD

It's my weekend off to relax, but unfortunately I had to go the emergency room to see another young man with a severe paintball gun injury.  He has lost almost all his vision in the left eye.  His eye, fortunately didn't burst like the last one -so I didn't need to spend 2 hours in the operating room piecing him back together.  This is the 6th young man I have seen with nearly total loss of vision in an eye due to a senseless paintball injury. One had to give up his dream of being an Air Force pilot.  One could no longer play football which was his passion.  The tragedy of it all is that they were just trying to have fun, and it was usually one of their best friends that pulled the trigger.  These paintball guns are so much more dangerous than BB guns because the whole idea is to shoot to kill another person (in a simulation, of course, of a real gunfight.) You're aiming at other people, not at a soda can or a target like you might with a BB gun.

Please take my advice.  If you ever get the crazy idea to play paintball, NEVER, EVER TAKE OFF YOUR EYE PROTECTION because that is exactly when you will get hit in the eye.  Remember Murphy's Law.  Whatever can go wrong, will go wrong.

Next time... my other biggest pet peave - weed wackers.

Michael Kutryb, MD