Acquired Trichomegaly with Topiramate

In 2005, a 25-year-old Hispanic female with bipolar disorder developed trichomegaly after starting treatment with topiramate, an anticonvulsant medication. She experienced increased thickness, stiffness, and length of her eyelashes after two months on a dosage of 100 mg taken orally four times a day. The trichomegaly ceased to progress one month after discontinuing the medication. This case was significant as it was the first reported instance of trichomegaly linked to psychotropic or anticonvulsant drugs, aside from generalized hypertrichosis caused by phenytoin. The timing suggested topiramate was the cause. The side effects were generally mild but the trichomegaly caused the patient distress and pain, indicating the importance of ophthalmologic evaluation for those with symptomatic trichomegaly to prevent complications like ectropion and corneal damage.