trimethoprim--sulfamethoxazole-drug-combination and Myopia

There are several isolated reports of systemic medications or medical conditions that can cause acute transient myopic shifts along with other ocular sequelae, but rarely has this been reported for the combination antibiotic sulfamethoxazole-trimethoprim.. This case illustrates a rarely seen condition that may result from treatment with sulfamethoxazole-trimethoprim and result in serious, vision-threatening conditions. These can be treated by immediate discontinuation of the drug, steroids, ocular hypertensive medication, and cycloplegia, depending on the circumstances.. A 20-year-old woman presented complaining of blindness upon waking. She had been experiencing fever, malaise, and significant abdominal pain for weeks. Blood culture revealed infection with Staphylococcus aureus and Escherichia coli for which she was prescribed sulfamethoxazole (800 mg) and trimethoprim (160 mg) twice daily. After a week of treatment, she awoke unable to see. Examination revealed narrowed angles, bilateral 6-D myopic shift, macular folding with scattered microaneurysms, and intraretinal hemorrhages with mild macular edema and field defects. The condition resolved with discontinuation of the drug and use of steroids, ocular hypertensive, and cycloplegic agents. Her visual acuity returned to near normal within 3 days. Resolution of macular edema, field defects, and hemorrhages followed.. An adverse reaction possibly caused by sulfamethoxazole-trimethoprim is described causing ciliochoroidal effusion resulting in acute myopic shift and other sequelae. Successful treatment is demonstrated, and implications are discussed.

Topics: Anti-Bacterial Agents; Bacteremia; Disease Progression; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Macular Edema; Myopia; Retinal Hemorrhage; Trimethoprim, Sulfamethoxazole Drug Combination; Vision Disorders; Visual Acuity; Visual Fields; Young Adult

We present a case of late acute myopia syndrome following discontinuation of treatment with a combination of sulphonamide drugs. To the best of our knowledge, this is the first reported case with such a presentation, and suggests that the pathophysiological basis for the acute myopia syndrome is a rapid decrease in serum carbonic anhydrase inhibitors levels which may lead to a rebound increase in the production of aqueous humor and accumulation of suprachoroidal fluid. It is further postulated that there may be a cumulative effect of sulphonamide drug use on carbonic anhydrase activity in the ciliary body epithelium of susceptible individuals.

Topics: Acute Disease; Adult; Anti-Infective Agents; Anticonvulsants; Drug Therapy, Combination; Female; Fructose; Humans; Intraocular Pressure; Migraine Disorders; Myopia; Pharyngitis; Topiramate; Trimethoprim, Sulfamethoxazole Drug Combination

Co-trimoxazole is a commonly used drug in the treatment and prophylaxis of opportunistic infections in HIV seropositive patients. We report a case of a 35-year-old HIV-infected man who presented with blurring of vision one week following initiation of co-trimoxazole therapy. A diagnosis of co-trimoxazole-induced myopia, a known idiosyncratic drug reaction, was made. The drug was withheld and the myopia resolved completely. Although in this patient the ocular condition resolved completely, serious ocular adverse reactions have also been reported with co-trimoxazole. This case report highlights the occurrence of ocular adverse drug reactions (ADRs) in HIV-infected patients on co-trimoxazole and the complexity of drug interactions.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Infective Agents; HIV Seropositivity; Humans; Male; Myopia; Trimethoprim, Sulfamethoxazole Drug Combination

(1) Acute myopia can be drug-induced. (2) Cholinergic drugs cause accommodative spasm responsible for myopia. (3) Many other drugs, such as sulphonamides, and diuretics, can cause myopia without accommodative spasm. (4) Early withdrawal of the responsible drug leads to rapid recovery.

Topics: Anti-Infective Agents; Anticonvulsants; Bromocriptine; Cyclophosphamide; Diuretics; Drug Therapy, Combination; Humans; Hydrochlorothiazide; Lens, Crystalline; Myopia; Triamterene; Trimethoprim, Sulfamethoxazole Drug Combination

We investigated the mechanism of drug-induced transient myopia, anterior chamber shallowing, and secondary angle-closure glaucoma in a young woman.. Ultrasound biomicroscopy was performed and the effects of cycloplegic eyedrops and unilateral laser iridotomy were evaluated.. Cycloplegic eyedrops and unilateral laser iridotomy had no effect. Ultrasound biomicroscopy identified the presence of a supraciliary choroidal effusion that caused forward displacement of the lens-iris diaphragm, resulting in increased myopia, anterior chamber shallowing, and angle-closure glaucoma. Discontinuance of trimethoprim and sulfamethoxazole combination led to the complete resolution of the condition.. Idiosyncratic drug reactions may produce a supraciliary choroidal effusion, resulting in myopia and secondary angle-closure glaucoma from the induced forward shift in the position of the crystalline lens and ciliary body.

Topics: Adult; Anterior Chamber; Anti-Infective Agents; Choroid; Choroid Diseases; Ciliary Body; Exudates and Transudates; Female; Glaucoma, Angle-Closure; Gonioscopy; Humans; Iris; Laser Therapy; Myopia; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography; Uveal Diseases

This report describes the occurrence of acute transient myopia in a patient treated with sulfonamide. We followed this patient by performing A-scan ultrasonographic ocular measurements documenting the anterior chamber depth, lens thickness, and axial length during the acute and convalescent periods. The outstanding feature in this case was the documented ultrasonographically significant reduction of the anterior chamber depth combined with lens thickening. This could be caused by a forward displacement of the lens as a result of allergic ciliary body edema and rotation. These changes could explain the mechanism of drug-induced transient myopia.

Topics: Acute Disease; Administration, Oral; Adult; Anterior Chamber; Anthropometry; Cystitis; Female; Humans; Myopia; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography

We performed acute and convalescent A-scan echographic ocular measurements documenting the anterior chamber depth, lens thickness, and axial length of a patient with acute transient sulfamethoxazole-induced myopia. Shallowing of the anterior chamber, independent of changes in the thickness of the lens, was the only anatomic variation found that could explain the myopia. Swelling of the ciliary body, with forward movement of the lens-iris diaphragm, could produce this transient anatomic change.

Topics: Adult; Anterior Chamber; Anti-Infective Agents, Urinary; Ciliary Body; Drug Combinations; Female; Humans; Lens, Crystalline; Myopia; Sulfamethoxazole; Sulfonamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination