Unilateral Glaucoma Secondary to Idiopathic Elevated Episcleral Venous Pressure: Recognizing the Rare

Abstract We report a case of glaucoma secondary to idiopathic elevated episcleral venous pressure (IEEVP) in a 58-year-old female who presented with dimness of vision in the right eye. Clinical evaluation revealed elevated intraocular pressure (IOP), dilated episcleral vessels, and blood in Schlemm’s canal on gonioscopy. Neuroimaging ruled out secondary causes of raised episcleral venous pressure. A diagnosis of glaucoma secondary to IEEVP was made. Given uncontrolled IOP despite maximum tolerated medical therapy and advanced optic nerve damage, the patient underwent trabeculectomy with Mitomycin-C. Postoperatively, IOP was well controlled with a functional bleb. This case highlights the importance of recognizing episcleral venous congestion as a clinical clue and the need for timely surgical intervention in managing IEEVP-related glaucoma.