Elevated Episcleral Venous Pressure (Idiopathic)
An otherwise healthy patient without past ocular history presented with left eye redness and no associated symptoms. Her examination was notable for corrected visual acuity of 20/15 and intraocular pressure of 14 mmHg on no topical treatment in the right eye and corrected visual acuity of 20/30 and intraocular pressure of 22 mmHg while on maximum medical therapy in the left. The remainder of the anterior segment examination showed abnormalities in the left eye including dilated, tortuous episcleral veins and blood in Schlemm’s canal. Dilated fundus exam revealed a normal posterior pole and optic nerve appearance in the right eye and significant optic nerve cupping of the left eye. Glaucoma testing demonstrated normal findings in the right eye and evidence of glaucomatous damage in the left eye including a diffusely constricted visual field with corresponding diffuse thinning on OCT RNFL imaging. An extensive workup did not reveal any orbital or neurological abnormality. The patient recently underwent trabeculectomy with mitomycin C and scleral window surgery with improved intraocular pressure. She will be followed regularly to promote maintenance of her vision and prevention of further glaucomatous damage and the development of other ocular complications.
Presentation Date: 06/22/2023
Issue Date: 07/07/2023
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