Cefixime-induced angle closure and transient myopic shift in
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A 49-year-old man presented with ocular pain and blurry vision from 1 week ago. The past ocular and systemic diseases were all negative. He has been using Cefixime 400 mg capsule (CEFIXIME 400MG CAP) twice a day since 1 week ago due to acute bacterial pharyngitis. On ocular examination, the best-corrected visual acuity (BCVA) of the right and left eyes were 20/30 and 20/20 respectively. The refractive error was ?3.75 and ?4.25 diopters in the right and left eye respectively. He had never had a visual problem to use corrective glasses. Intraocular pressure measured by Goldmann applanation tonometer was 32 mm Hg in the right eye and 40 mm Hg in the left eye.

Slit-lamp examination in both eyes showed chemosis, mild cortical cataract, and shallow anterior chamber (AC). In gonioscopy, there was 360° appositional angle closure. Funduscopic examination showed pink and sharp optic disc with Cup/disc ratio of 0.4 in both eyes. Based on the history of the patient and ocular examinations, a diagnosis of secondary acute angle-closure disease induced by systemic medications was made. Ultrasound biomicroscopy was then performed which showed shallow anterior chamber, narrow-angle, supraciliary effusion, and anterior rotation of the ciliary body in both eyes. By considering the pathophysiology of the disease, oral Cefixime was discontinued and oral prednisolone 50 mg/day (PREDNISOLONE- FORT 50MG TAB, Aburaihan Pharmaceutical Company, Iran), eye drop Betamethasone (BETAMETHASONE DP 0.1% 5ML OPH DROP) every 4 hours, eye drop Cosopt (COSOPT Drop, Ophthalmic 2/0.05%,5 ml) and Brimonidine (BRIMONIDINE DP 0.2% OPH DROP) twice a day and eye drop Atropine Sulfate 1% (Atrin 1% OPH DROP) twice a day were prescribed.

On the next day, the ocular symptoms were improved with a 20% reduction in IOP and myopia in both eyes. After 5 days of starting medications, myopic shift elevated IOP, and supraciliary effusion was resolved completely in both eyes. Also, refractive error reached ?0.5 diopter with BCVA of 20/20 in both eyes. In gonioscopy, the angle was open in all quadrants with no signs of synechia formation.