Which diuretic can cause acute secondary angle closure similar to Topamax?

• A. Acetazolamide
• B. Furosemide
• C. Hydrochlorothiazide
• D. Spironolactone

Answer: (C)

A diuretic can provoke acute secondary angle-closure glaucoma when it triggers ciliochoroidal effusion, causing the iris-lens diaphragm to move forward and the anterior chamber to shallow, producing a sudden rise in intraocular pressure. This is the mechanism seen with Topamax in susceptible individuals, and some sulfonamide-containing diuretics can cause the same effect.

Hydrochlorothiazide fits this pattern. It’s a thiazide diuretic with a sulfonamide group, and there are reports of thiazides precipitating ciliochoroidal effusion leading to acute angle-closure in rare cases. The other diuretics don’t share this association: acetazolamide is a sulfonamide but is used to lower IOP and treat acute angle-closure rather than precipitate it; furosemide and spironolactone are not commonly linked to this mechanism and are not typically implicated in triggering acute angle-closure glaucoma.