We examined a 39-year-old female with severe headache and blurred vision. She was on topiramate, 50 mg once a day for one week because of migraine. Periorbital edema, chemosis, myopia, high intraocular pressures, and shallow anterior chambers were present at the initial examination. Iridocorneal angles were closed, ultrasound showed choroidal effusions. We stopped topiramate and started antiglaucoma treatment. After one week the intraocular pressure was 10 mm Hg in both eyes without treatment. A new ultrasound showed no choroidal effusions. Topiramate has been associated with acute secondary angle closure glaucoma as an idiosyncratic reaction to the drug. Physicians prescribing topiramate need to alert patients of this potential sight-threatening idiosyncratic reaction.

No abstract

Cyclic esotropia is an extremely uncommon form of strabismus. Classically, it follows a 48-hour cycle with 24 hours of orthotropia and 24 hours of manifest esotropia. We are reporting the first case of cyclic esotropia with a 24-hour cycle. A 7-year-old hyperopic female was seen with an esotropia of 6-month duration. Hyperopic glasses were prescribed by another ophthalmologist prior to our evaluation of the patient. While wearing her glasses, esotropia occurred during the morning and early afternoon. After 3.00pm, her eyes were “straight.” Many photographs were reviewed, confirming the esotropia pattern. Neurological evaluation was normal, including imaging and blood work to rule out thyroid pathology and myasthenia. After seeing the patient multiple times at different hours on different days, the diagnosis of cyclic esotropia was made. Bimedial recessions were performed with good results. The patient was still “straight” at distance and near 2 years after surgery.

Background: Conjunctiva can be restrictive in long-standing strabismus. To date, there are no reports in the literature describing the histology of the conjunctiva in these patients. Methods: Conjunctiva biopsies over the medial and lateral rectus were taken at the time of strabismus surgery in 3 patients with restrictive large angle long-standing esotropia. Results: The conjunctiva overlying the medial rectus has a much more condensed, organized lamina propria compared to the conjunctiva of the contralateral lateral rectus. The medial conjunctiva has scattered small-diameter vessels and numerous clusters of plasmatic cells. The lateral conjunctiva has large blood vessels with occasional scattered plasmatic cells and the lamina propria present a lax structure. Conclusions: These new findings reinforce the clinical understanding that conjunctiva can become more restrictive over the medial rectus in long-standing esotropia.