Título

GLAUCOMA SECONDARY TO ELEVATED EPISCLEARAL VENOUS PRESSURE (EVP)

Objetivo

Describe a rare case of a patient with glaucoma secondary to elevated episcleral venous pressure (EVP), detailing the main findings and how to proceed. The diagnosis is based on the clinical findings of prominent (arterialized) episcleral veins (Fig. 1 and 2), elevated IOP and an open angle on gonioscopy.

Relato do Caso

A 73-year-old female, caucasian, reported that she had a indication for cataract surgery, she was unaware of any prior eye disease.
She reports that just before the surgery, there was evidence of an increase in the episclearal vessels in the left eye (LE), with a consequent increase in intraocular pressure (IOP). Denied previous comorbidities.
In use of Drusolol® and Lumigan RC®, with best correction visual acuity of 20/30 in the right eye (RE) and 20/40 in the LE. IOP was 10/20 mmHg.
Biomicroscopy showed N1 cataract and dilated episcleral and conjunctival vessels in LE.
Fundoscopy showed subtotal excavation of the optic nerve in both eyes (BE).
Tomography of the skull and orbits, as well as Doppler ultrasonography of the eyeball, ophthalmic arteries and supraorbital veins, showed no abnormalities.
Optic Disk OCT, showed reduction in NFC in all quadrants in the LE of the Nerve Fiber Layer (NFC) in the LE.
She had a open angle on gonioscopy on BE.
The diagnostic hypothesis of idiopathic episcleral venous hypertension was suggested, a diagnosis of exclusion, since intracranial and intraorbital pathologies had been excluded.
Glaub MD® were prescribed and the IOP was normalized with 14/13 mmHg.
Patient currently undergoing monitoring intraocular pressure.

Conclusão

Causes of elevated EVP may be divided into three different groups: venous obstruction, which includes
thyroid ophthalmopathy, retrobulbar tumor, épiscleral or orbital vein vascults; obstriction of the sunenor vena cava: arteriovenous anomalies, including carotid artery-cavernous sinus fistula, dural shunts, and Sturge Weber syndrome; and idiopatic.
It is essential to make a correct diagnosis, using an arsenal of appropriate tests, to avoid from being chronically untreated.