Abstract
BackgroundIdiopathic elevated episcleral venous pressure (IEEVP) or idiopathic dilated episcleral veins (IDEV) is a rare abnormality, and thus therapeutic treatment for this condition rarely is discussed. We report a case of a patient with bilateral glaucoma secondary to IDEV for whom intraocular pressures (IOPs) were controlled successfully by trabeculectomy.Case presentationA 50 year-old female with a complaint of persistent red eyes for over 30 years, presented with numerous tortuous and engorged episcleral vessels in both eyes (OU), open angles OU with spontaneous blood in Schlemm’s canal 360 degrees bilaterally. Orbital color Doppler examination showed the superior ophthalmic veins to be of normal calibre, with no reversal of flow. Head MRI with contrast and cerebral angiography were negative for arteriovenous fistula. Coronary angiography, color Doppler echocardiography and chest radiographs were within normal limits. A diagnosis of secondary glaucoma and IDEV was made. Neither anti-glaucoma medications, nor laser trabeculoplasty reduced the patent’s IOP effectively. Only after trabeculectomy was performed in each eye, were IOPs successfully controlled.ConclusionsThis case serves to remind clinicians of the importance of identifying and evaluating thoroughly patients with episcleral vessel dilation in non-inflamed eyes with no known cause. A misdiagnosis or missed diagnosis of long-term elevated intraocular pressure may result in significant damage to the optic nerve. In addition, when performing filtration surgery it is crucial that the ophthalmologist control the IOP and make an effort to prevent choroidal effusion.
Highlights
Idiopathic elevated episcleral venous pressure (IEEVP) or idiopathic dilated episcleral veins (IDEV) is a rare abnormality, and therapeutic treatment for this condition rarely is discussed
A misdiagnosis or missed diagnosis of long-term elevated intraocular pressure may result in significant damage to the optic nerve
Three days after the initial presentation (July 19, 2016), the intraocular pressure reduced to 24 mmHg right eye (RE) and 21 mmHg left eye (LE) with use of carteolol hydrochloride 2% and Discussion IEEVP or IDEV is an uncommon cause of secondary open-angle glaucoma, first described by Minas and Podos [4], and has no apparent predilection in regard to age or gender
Summary
IEEVP or IDEV is characterized by dilated episcleral vessels and open-angle glaucoma without an underlying cause. By excluding other possible conditions, in particular a non-typical cavernous-sinus fistula, for which the diagnosis can be eliminated through cerebral angiography and orbital color Doppler evaluation, can the clinical diagnosis of IEEVP or IDEV be established. It is essential that the clinician evaluate thoroughly patients who present with episcleral vessel dilation and non-inflamed eyes. XR drafted the manuscript, and the manuscript was critically revised by ML. Both authors read and approved the final version published. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
