Woman in her 60s experiences choroidal effusion after topical dorzolamide treatment

US clinicians have described their treatment of a patient who developed a unilateral serous choroidal effusion after initiating topical dorzolamide treatment.

Writing in BMJ Case Reports, Ohio State University Wexner Medical Center clinicians highlighted that a woman in her 60s presented to the emergency department after experiencing redness, irritation and blurred vision in her left eye.

The patient had a history of severe primary open-angle glaucoma (POAG) in the left eye. Three days before attending the emergency department, she had started topical dorzolamide hydrochloride 2%treatment in her left eye only for elevated intraocular pressure.

A slit lamp examination of the patient’s left eye revealed diffuse conjunctival injection, diffuse corneal superficial punctate keratopathy, and absence of intraocular inflammation.

At a follow up two days after her initial presentation, the patient’s symptoms had continued to worsen despite discontinuing dorzolamide treatment.

A fundoscopic examination showed new serous choroidal effusions in the nasal and temporal periphery.

The patient was treated with topical cyclopentolate hydrochloride 1% twice daily and topical prednisolone acetate 1% six times daily.

Once the choroidal effusions had resolved, medication was tapered. Since discontinuing dorzolamide treatment, the patient has not had a recurrence of choroidal effusions.

“Her severe POAG has since remained clinically stable on long-standing topical brimonidine,” the authors highlighted.

Reflecting on the insight gained from the case, the clinicians shared: “After initiation of topical dorzolamide, patient report of ocular irritation and decreased visual acuity warrants a full slit lamp, fundoscopic exam and possible fundoscopic imaging and ocular ultrasound to examine for possible medication side effects.”