myopia induction by drugs

1. Myopia Induction by
Chlorthalidone- Case Series
FP794
Poster Podium Presentation at AIOC 2023
-Dr Lakshmi K S Murthy

2. Introduction:
• Transient drug-induced myopia is a known entity
• Transient myopia and angle closure glaucoma are reported side
effects of various drugs like
Indapamide,2 hydrochlorothiazide,3 triamterene3 and topiramate
• We report a case series of development of acute myopia and acure
angle closure after the oral intake of Chlorthalidone, used for
treating systemic hypertension.

3. Materials and Methods: Case 1
• Relevant History:
• 25 year old male patient
• Sudden DOV-1 day
• Recent onset hypertension- DOV 4 hours
after the intake of 1st dose of tab
Chlorthalidone 12.5mg
• His previous refraction showed
emmetropia
RIGHT EYE LEFT EYE
UCVA 6/60 6/60
Subjective
correction-
BCVA
-4.00 DS/-1.00
DC*90 -6/6
-4.50 DS/-1.00
DC*90 – 6/6
Anterior segment Normal Normal
Anterior
Chamber
Shallow AC Shallow AC
Dilated fundus
evaluation
Normal Normal
Gonioscopy Open Open
B Scan Normal Normal
AS OCT Normal Normal
IOP 12 14
Ocular examination

4. • Provisional diagnosis:
• Chlorthalidone induced acute myopia
• Treatment:
• Stop tab Chlorthalidone
• 2% Homatropine eye drops bd for 1 week
• Refraction after 2 weeks
• UCVA OU-6/6

5. Materials and Methods: Case 2
• Relevant History:
• 45 year old male patient
• Sudden DOV with glasses- 1 week
• Glasses prescribed by an optician over the counter
1 month back when he developed sudden DOV
• K/C/O HTN on tab metaprolol 50mg
• Retrospective questioning- was on Tab amlovas
(amlodipine 5mg +chlorthalidone 12.5 mg)-
changed 3 weeks back
RIGHT EYE LEFT EYE
VA with
glasses
6/60 6/60
UCVA 6/6 6/6
PGP -5.00 -6.00
Anterior segment Normal Normal
Dilated fundus
evaluation
Normal Normal
Gonioscopy Open Open
B Scan Normal Normal
AS OCT Normal Normal
IOP 12 14
Ocular examination

6. • Provisional diagnosis:
• Chlorthalidone induced acute myopia which has reversed on withdrawal of
drug co-incidentally
• Treatment:
• Advice discontinuing the use of glasses
• Create awareness with the patient and their physician regarding
Chlorthalidone’s effect on their eyes

7. Materials and Methods: Case 3
• Relevant History:
• 64 year old male patient
• Sudden painful DOV 1 day, associated
with headache
• History of both eye cataract surgeries
10 years back
• K/C/O HTN since 5 years, on tab Tab
amlovas (amlodipine 5mg
+chlorthalidone 12.5 mg)
Ocular examination
RIGHT EYE LEFT EYE
UCVA 6/60 6/60
Subjective
correction-BCVA
-4.00 DS/-1.00 DC*90
– 6/24
-4.50 DS/-1.00
DC*90- 6/18
Cornea Central hazyness Central hazyness
Anterior Chamber Shallow quiet AC Shallow quiet AC
Lens PCIOL PCIOL
Dilated fundus
evaluation
Choroidal
detachment
Choroidal
detachment
Rest of Anterior segment Normal Normal
IOP 28 32
Gonioscopy Closed 360 Closed 360
B Scan Choroidal
detachment
Choroidal
detachment

8. OD OS

9. • Provisional diagnosis:
• Chlorthalidone induced acute angle closure with CD and myopia
• Treatment:
• Stop tab Chlorthalidone
• Oral steroids with antacids
• Short term Oral and topical AGM
• No need of yag PI
• after 2 months
• BCVA OU-6/6, ocular examination- unremarkable

10. Discussion
• Ocular effect of the drug chlorthalidone -transient acute myopia, acute
angle closure glaucoma, choroidal detachment
• Mechanism: Allergic reaction to the drug. Ciliary spasm, ciliary body
edema. No role of lens hydration
• Drug continued- irreversible sight loss
• Responsibility of correct diagnosis- on ophthalmologist

11. Conclusion:
• Awareness is the key to diagnosing this
• Its prudent to do an AS-OCT and B-
scan to rule out angle closure and
choroidal effusion
• Drug withdrawal with supportive
treatment for cycloplegia and glaucoma
is the treatment

12. `
Thank You