Lorazepam-induced diplopia
The present case is about a 21-year-old male patient who was admitted to the psychiatry unit of a tertiary care teaching hospital in South India. He had no history of similar condition or any significant past medical or family history. Patient presented with the complaints of persistent pre-occupation with sexual and contamination thoughts, insomnia, increased fearfulness, memory impairment and anxiety and repeated hand washing. Based on the symptoms a provisional diagnosis of depression with obsessive compulsive disorder (OCD) was made and subsequently patient was diagnosed as suffering from OCD. Patient was prescribed lorazepam 4 mg intravenous (IV) stat and later as required for the severe anxiety symptoms. Tablet clomipramine 25 mg at night and tablet sertraline 50 mg were prescribed in the morning to treat OCD. The patient received lorazepam 4 mg IV and clomipramine 25 mg at 9 pm on day 1 and woke up next morning at 6 am complaining of giddiness, diplopia and unstable gait. Patient was receiving no other medication, including over the counter medications. He had never experienced similar complaints before. As diplopia was a new symptom the mental health team requested for a neurological and ophthalmic consultation to determine the possible underlying causes. However, diplopia resolved at 12 h of onset. Ophthalmologic and neurologic observations were insignificant. Meanwhile based on literature search and detailed review of the patient's medical history, lorazepam was suspected to be the causal agent for this adverse reaction and discontinued. However, patient continued to receive clomipramine and sertraline during the remaining 4 days of his hospital stay without reoccurrence of diplopia or any other visual problems.\nA causal association between diplopia and lorazepam was assessed by World Health Organization probability scale and Naranjo's algorithm it showed “probable” association between the adverse reaction and lorazepam.