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Idiopathic dilated episcleral veins and increased intraocular pressure
  1. R Foroozan,
  2. L M Buono,
  3. P J Savino,
  4. R C Sergott
  1. Neuro-Ophthalmology Service, Wills Eye Hospital, Thomas Jefferson University, 900 Walnut Street, Philadelphia, PA 19107, USA
  1. Correspondence to: P J Savino, Neuro-Ophthalmology Service, Wills Eye Hospital, Thomas Jefferson University, 900 Walnut Street, Philadelphia, PA 19107, USA; pjsavino{at}aol.com

https://doi.org/10.1136/bjo.87.5.652

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    Intraocular pressure (IOP) is dependent on the rate of aqueous production, facility of outflow, and episcleral venous pressure. Increased IOP and visual field loss may result from an elevation of episcleral venous pressure, the causes of which include large vessel venous obstruction (venous sinus thrombosis and superior vena cava syndrome), arteriovenous shunts or fistulas, Sturge-Weber syndrome, scleritis, thyroid related orbitopathy, and orbital tumours.1 Increased episcleral venous pressure may result in elevated IOP and optic neuropathy, even in the absence of these entities. We report a 34 year old man with idiopathic dilated episcleral veins (IDEV) and increased IOP, with visual field loss.

    CASE REPORT

    A 34 year old man presented for neuro-ophthalmic evaluation because of decreased vision in the right eye and injection of both eyes. His intraocular pressure (IOP) had been elevated in the right eye more than the left for the past 13 years, reaching 32 mm Hg in the right eye. His eyes appeared red for as long as he could remember, but details of his previous ophthalmic examinations were unavailable. Because of the bilateral injection he saw two other neuro-ophthalmologists, who suspected an arteriovenous fistula. One year before presentation he underwent magnetic resonance imaging (MRI) of the head and orbits and catheter arteriography on two occasions, which were both normal. He had no other previous medical problems, was taking …

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