Medical Management of Glaucoma Secondary to Idiopathic Elevated Episcleral Venous Pressure

Idiopathic elevated episcleral venous pressure (IEEVP) is a rare cause of secondary open-angle glaucoma.The authors report a case of a 36-year male who presented with dilated episcleral vessels in the right eye.Gonioscopy revealed bilateral open angles with blood in Schlemm's canal in the right eye.Dilated retinal examination showed advanced glaucomatous optic neuropathy in the affected eye.Notably, the patient was also a known case of Gilbert syndrome.A thorough multidisciplinary evaluation, including orbital and neuroimaging as well as laboratory work-up, was undertaken to rule out secondary causes of elevated episcleral venous pressure (EVP) such as carotid-cavernous fistula, Sturge-Weber syndrome, or thyroid eye disease.The patient has been managed conservatively with topical antiglaucoma medications for the past two years, maintaining stable intraocular pressure and visual fields.The plan is to proceed with augmented trabeculectomy if any deterioration occurs, keeping in view the possibility of choroidal effusions.