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- Primary pulmonary arterial hypertension
- chronic ocular ischaemic syndrome
- Secondary glaucoma
- dilated episcleral veins
- intraocular pressure
A 50-year-old man was referred to the ophthalmology emergency unit for visual loss of 5 days' duration. He had been emmetropic in the past and had been treated with prostaglandin drops for ocular hypertension in both eyes, but had stopped any specific follow-up and treatment many years previously. Past medical history was significant for angina pectoris, without any relevant family history. On examination, best-corrected visual acuity was right 20/200 with −2.25 DS, and left count fingers. Slit-lamp examination showed dilated episcleral veins bilaterally, which had been present since his twenties, according to the patient; in the right eye (RE) the minor arterial circle of the iris was dilated, and the angle was open, while rubeosis iridis and a hyphaema were observed in the left eye (LE) (figure 1). Intraocular pressure (IOP) was right 28 mm Hg and left 52 mm Hg. Fundus examination revealed a large neurosensory retinal detachment in the RE, but no view was possible in the LE. The patient was fatigued, cyanosed and dyspnoeic, with a pulse rate of 74 bpm and blood pressure of 120/80 mm Hg. Further history revealed constitutional symptoms over the last 2 years with a 20 kg weight loss. The haemoglobin level was 20.7 g/dl. Cardiac ultrasonography and right heart catheterisation were …
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.