Idiopathic Elevated Episcleral Venous Pressure with Secondary Glaucoma

Cymbor, Michael; Knapp, E; Carlin, Fred H.

doi:10.1097/opx.0b013e31829689a6

Cited by 7 publications

(4 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Secondly, it would be prudent to keep in mind the cause-effect relationship of episcleral venous congestion. Literature has numerous reports of bilateral idiopathic dilated episcleral venous congestion leading to bilateral glaucoma 5 , 6 , 7 as well as unilateral idiopathic dilated episcleral venous congestion leading to ipsilateral glaucoma. 8 , 9 Groh MJ et al 10 even reported a case of the Radius-Maumenee syndrome.…”

Section: Discussionmentioning

confidence: 99%

Congenital isolated idiopathic episcleral arteriovenous malformation

Gandhi

Naik²,

Mehta

2020

American Journal of Ophthalmology Case Reports

View full text Add to dashboard Cite

Purpose To report the occurrence of an episcleral AVM and to discuss the gravity as well as management of dilated tortuous episcleral vasculature. Observation A 16-year-old Asian male presented with redness in the left eye since birth and a history of gradual painless progressive increase in size since the past two years, causing a cosmetic concern for the patient. There was no history of any diminution of vision, diplopia, headache, trauma or any similar lesions anywhere in the body. On examination, unaided visual acuity (UCVA) was 6/6 Snellen in both eyes. Hirschberg's reflex was central and extraocular movements were full and free in both the eyes. On slit-lamp examination, dilated tortuous episcleral vessels were found in the temporal aspect of the palpebral aperture, shaped like a single continuous vascular frond, vertically measuring 10–11mm in extent and horizontally commencing 6mm from the temporal limbus but the posterior limit could not be discernible. The episcleral plane was freely mobile from the overlying conjunctiva and underlying sclera. The dilated episcleral vasculature remained unchanged on Valsalava maneuver and on bending forward. Intraocular pressure was 14 mmHg by Goldmann's appalanation tonometer in both eyes. Iris was normal in configuration and gonioscopy revealed open angles without any evidence of any neovascularisation in both eyes. Fundus examination was unremarkable. USG B-scan was grossly normal. MR Angiography of head and orbit with using thin high-resolution cuts (1mm using 3T machine) was done and was later followed up with a Contrast Enhanced MRI. Both imaging studies revealed an isolated episcleral AVM with a possible feeder vessel from the anterior ciliary artery to the lateral rectus and without any intraorbital or intracranial lesion. A diagnosis of isolated episcleral AVM was made. The episcleral plane was dissected and dilated tortuous vessels were excised. After cautery, conjunctival autograft was obtained from the fellow-eye was used to cover the defect. Histopathological examination revealed both thick and thin walled vessels of varying calibre corresponding to arteries and veins confirming the diagnosis of isolated episcleral AVM. Ref. Fig. 2. No recurrence has been observed over a follow-up period of 1 year. Conclusion AND IMPORTANCE: Isolated idiopathic episcleral AVM should be a diagnosis of exclusion. A thorough systemic and ophthalmological evaluation including a glaucoma workup is necessary for both diagnosis and management. UBM and MRI/MRA may be required in select cases to rule out any associations or complications. Management includes observation, embolization and excision.

show abstract

Section: Discussionmentioning

confidence: 99%

Congenital isolated idiopathic episcleral arteriovenous malformation

Gandhi

Naik²,

Mehta

2020

American Journal of Ophthalmology Case Reports

View full text Add to dashboard Cite

show abstract

“…Additionally, CCFs can result in neovascular glaucoma due to retinal hypoperfusion and ischemia [90,93,94]. While some cases of elevated EVP are due to identifiable etiologies, others are characterized as idiopathic elevated episcleral venous pressure (IEEVP) presenting with engorged episcleral veins, raised IOP, and/or glaucomatous visual field changes [94][95][96][97]. The elevated IOP due to vascular abnormities can cause compression of RGCs and their axons, as well as reduced ocular blood supply, leading to the development of glaucoma [15].…”

Section: The Role Of Vascular Abnormalities In Regulating Iopmentioning

confidence: 99%

The Association between Vascular Abnormalities and Glaucoma—What Comes First?

Wang,

Liu

et al. 2023

IJMS

View full text Add to dashboard Cite

Glaucoma is a leading cause of irreversible blindness worldwide. While intraocular pressure (IOP) presents a major risk factor, the underlying pathophysiology still remains largely unclear. The correlation between vascular abnormalities and glaucoma has been deliberated for decades. Evidence for a role played by vascular factors in the pathogenesis of glaucomatous neurodegeneration has already been postulated. In addition, the fact that glaucoma causes both structural and functional changes to retinal blood vessels has been described. This review aims to investigate the published evidence concerning the relationship between vascular abnormalities and glaucoma, and to provide an overview of the “chicken or egg” dilemma in glaucoma. In this study, several biomarkers of glaucoma progression from a vascular perspective, including endothelin-1 (ET-1), nitric oxide, vascular endothelial growth factor (VEGF), and matrix metalloproteinases (MMPs), were identified and subsequently assessed for their potential as pharmacological intervention targets.

show abstract

“…5A), Sturge-Weber syndrome, orbital tumors, scleritis, thyroid-related orbitopathy, or large vessel venous obstruction 26,28,29. Elevated EVP can also occur in the absence of any apparent cause (idiopathic elevated EVP) 30,31. Patients with elevated EVP associated with these conditions usually present with severe conjunctival hyperemia, high IOP, and open-angle glaucoma that is difficult to treat 29–31.…”

Section: Relationship Between Episcleral Vessel Diameter Evp and Iopmentioning

confidence: 99%

“…Elevated EVP can also occur in the absence of any apparent cause (idiopathic elevated EVP) 30,31. Patients with elevated EVP associated with these conditions usually present with severe conjunctival hyperemia, high IOP, and open-angle glaucoma that is difficult to treat 29–31. Several cases of severe conjunctival hyperemia and elevated IOP associated with delayed hypersensitivity to brimonidine (Fig.…”

Section: Relationship Between Episcleral Vessel Diameter Evp and Iopmentioning

confidence: 99%

Episcleral Venous Pressure and the Ocular Hypotensive Effects of Topical and Intracameral Prostaglandin Analogs

Lee

Robinson

Weinreb

2019

Journal of Glaucoma

View full text Add to dashboard Cite

There is a limit beyond which increasing either the concentration of a prostaglandin analog (PGA) or its dosing frequency fails to produce increases in ocular hypotensive efficacy with topical dosing. Intracameral PGA dosing with a bimatoprost implant, however, does not exhibit the same intraocular pressure (IOP)-lowering plateau at studied concentrations, and the maximum-achievable ocular hypotensive effects are not yet known. This suggests that the bimatoprost intracameral implant may activate another mechanism of action in addition to the mechanism(s) activated by topical application. Episcleral venous pressure (EVP) is a key determinant of IOP, and experimental manipulation of the episcleral vasculature can change both EVP and IOP. The recent observation that topical and intracameral PGA drug delivery routes produce different patterns of conjunctival hyperemia suggested that the differences in the IOP-lowering profiles may be caused by differing effects on the episcleral vasculature. Recent experiments in animals have shown that topical PGAs increase EVP, while the bimatoprost intracameral implant causes a smaller, transient increase in EVP, followed by a sustained decrease. The increase in EVP could be limiting the IOP-lowering efficacy of topical PGAs. In contrast, the decrease in EVP associated with the bimatoprost implant could explain its enhanced IOP-lowering effects. Further research on EVP as a target for IOP lowering is indicated to improve our understanding of this potentially important pathway for treating patients with glaucoma.

show abstract

Idiopathic Elevated Episcleral Venous Pressure with Secondary Glaucoma

Abstract: Although rare, IEEVP should be considered when the patient presents with elevated IOP in the presence of engorged episcleral veins. Idiopathic elevated episcleral venous pressure is often difficult to manage both medically and surgically.

Cited by 7 publications

References 6 publications

Congenital isolated idiopathic episcleral arteriovenous malformation

Congenital isolated idiopathic episcleral arteriovenous malformation

The Association between Vascular Abnormalities and Glaucoma—What Comes First?

Episcleral Venous Pressure and the Ocular Hypotensive Effects of Topical and Intracameral Prostaglandin Analogs

Contact Info

Product

Resources

About