Korean J Ophthalmol.  2013 Apr;27(2):141-144. 10.3341/kjo.2013.27.2.141.

Increased Intraocular Pressure after Extensive Conjunctival Removal: A Case Report

• Lee YR
• Na JH
• Kim JY
• Sung KR

• KMID: 1503809
• DOI: http://doi.org/10.3341/kjo.2013.27.2.141

Abstract

A 50-year-old woman, who had undergone extensive removal of conjunctiva on the right eye for cosmetic purposes at a local clinic 8 months prior to presentation, was referred for uncontrolled intraocular pressure (IOP) elevation (up to 38 mmHg) despite maximal medical treatment. The superior and inferior conjunctival and episcleral vessels were severely engorged and the nasal and temporal bulbar conjunctival areas were covered with an avascular epithelium. Gonioscopic examination revealed an open angle with Schlemm's canal filled with blood to 360 degrees in the right eye. Brain and orbital magnetic resonance imaging and angiography results were normal. With the maximum tolerable anti-glaucoma medications, the IOP gradually decreased to 25 mmHg over 4 months of treatment. Extensive removal of conjunctiva and Tenon's capsule, leaving bare sclera, may lead to an elevation of the episcleral venous pressure because intrascleral and episcleral veins may no longer drain properly due to a lack of connection to Tenon's capsule and the conjunctival vasculature. This rare case suggests one possible mechanism of secondary glaucoma following ocular surgery.

Keyword

Episcleral venous pressure; Glaucoma; Intraocular pressure

MeSH Terms

Adult
Conjunctiva/*blood supply/*surgery
Female
Glaucoma, Open-Angle/*etiology/pathology
Gonioscopy
Humans
*Intraocular Pressure
Postoperative Complications/*etiology/pathology
Surgery, Plastic/adverse effects

Figure

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  Fig. 1 Optical coherence tomography retinal nerve fiber layer (RNFL) scans obtained (A) preoperatively, and (B) 4 months after surgery. Average RNFL thickness in the right eye fell from 91.77 microns to 78.09 microns.

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  Fig. 2 (A,B) Anterior segment examination of the right eye, demonstrating episcleral and conjunctival engorgement in the superior and inferior areas. (C) The temporal bulbar conjunctiva lacked conjunctival vessels and was covered with a thin epithelium, with few engorged episcleral vessels. (D) Gonioscopic examination demonstrated an open angle with blood in Schlemm's canal.

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