A 22-year-old previously healthy female from Guatemala presents as a referral for “severe glaucoma” with symptoms of intermittent headaches and gradual decline in vision most notable in the left eye. On exam the patient is found to have low-normal intraocular tension, open angle structures without evidence of pigment or inflammation, and glaucomatous cupping of the optic nerves. Further studies revealed inferior and superior retinal nerve fiber layer loss and diffuse thinning of the ganglion cell layer. Humphrey visual fields demonstrated a dense superior arcuate and inferior nasal step in the right eye and marked constriction in the left eye. A diagnosis of normal tension glaucoma was made and the patient was started on brimonidine.
Presentation Date: 02/21/2019
Issue Date: 08/01/2020