Toxic optic neuropathy and acute angle closure secondary to divalproex sodium – A rare case report

Abstract

This study aims to report the side effects of oral divalproex sodium in a 55-year-old woman presented with a bilateral sudden painless decrease of vision and frontal headache and nausea, causing unique development of optic neuropathy and secondary acute angle closure (AAC). She gave a history of taking oral divalproex sodium for her migraine headache for 2 weeks. On examination, the patient was found to have secondary AAC, optic neuropathy with high intraocular pressure, and optic disc edema in both eyes (BE). The patient was treated with topical medications. The best-corrected distance visual acuity revealed an improvement of 20/30 from hand movement in BE within 2 weeks from the initial presentation. The ocular side effect, induced by divalproex sodium and possibly even after withdrawal from the drug, on time early detection of secondary AAC, and optic neuropathy will improve the management and give optimal results.