J Korean Ophthalmol Soc.  2015 Nov;56(11):1810-1816. 10.3341/jkos.2015.56.11.1810.

Internal Jugular Vein Thrombosis Presenting with Elevated Intraocular Pressure

• Choi YJ
• Kim YT

• KMID: 2214193
• DOI: http://doi.org/10.3341/jkos.2015.56.11.1810

Abstract

PURPOSE
To report a case of elevated intraocular pressure (IOP) caused by internal jugular vein thrombosis.
CASE SUMMARY
A 58-year-old male diagnosed with diabetic retinopathy visited our clinic for a regular checkup. On ophthalmic examination, IOP was 30 mm Hg in the right eye and 28 mm Hg in the left eye. Slit lamp examination showed chemosis, conjunctival injection and slight corneal edema in both eyes. Additionally, gonioscopic examination showed open angle. We observed face edema that started 1 month prior and he was diagnosed with internal jugular vein thrombosis on the right side, internal jugular vein and innominate vein stenosis on the left side approximately 2 months ago. The patient underwent percutanoeus transluminal angioplasty for dilating stenosed vessel. Four days after the procedure, his IOP was 15 mm Hg in the right eye and 12 mm Hg in the left eye based on Goldman applanation tonometer and was well maintained.
CONCLUSIONS
Internal jugular vein thrombosis on both sides can cause an increase in IOP.

Keyword

Episcleral vein pressure; Internal jugular vein thrombosis; Intraocular pressure

MeSH Terms

Angioplasty
Brachiocephalic Veins
Constriction, Pathologic
Corneal Edema
Diabetic Retinopathy
Edema
Humans
Intraocular Pressure*
Jugular Veins*
Male
Middle Aged
Thrombosis*

Figure

• 

  Figure 1. Face and anterior segment photograph before and after percutaneous transluminal angioplasty. (A, C, D) Clinical photog-raphy shows prominent face edema and chemosis before percutaneous transluminal angioplasty (PTA). (B, E, F) Recovery of face swelling and chemosis was observed after PTA at left innominate vein (or brachiocephalic vein). OD = oculus dexter; OS = oculus sinister.

• 

  Figure 2. The changes of fundus photography according the changes in intraocular pressure. (A, B) Fundus photography shows that optic disc was seen a little pale in the left eye but, the retina and optic disc in both eyes was dimly visible (IOP 30/28 mm Hg). (C, D) Two weeks after PTA, fundus photography shows that the retina and optic disc is seen more clearly (IOP 14/12 mm Hg). IOP = intraocular pressure; PTA = percutanoeus transluminal angioplasty.

• 

  Figure 3. Visual field examination and optical coherence tomography (OCT) before and after percutaneou transluminal angioplasty (PTA). (A-D) Humphrey visual field testing revealed a central island of vision in the right eye and showed clover leaf pattern in the left eye. (E) Before PTA, OCT dose not showed significant RNFL thinning in both eyes. (F) But, RNFL thinning in the nasal region in TSNIT graph after PTA. OD = oculus dexter; OS = oculus sinister; RNFL = retinal nerve fiber layer; TSNIT = temporal-supe-rior-nasal-inferior-temporal.

• 

  Figure 4. CT images of internal jugular vein thrombosis. Post-contrast neck CT images of coronal section (A) and sagittal view (B) showed a complete thrombosis of the right internal jugular vein without any flow (white arrows) and (C) partial stenosis of the left internal jugular vein (black arrow) and the innominate vein (white arrow). CT = computed tomography.

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  Figure 5. Before and after digital subtraction angiography (DSA) image of Percutaneous transluminal angioplasty. Images show (A) segmental stenosis on the innominate vein (or brachiocephalic vein, white arrow) and internal jugular vein (black arrow) in left side. (B) Percutanoeus transluminal angioplasty with balloon dilation catheter was done through left forearm graft fisula. (C) DSA dem-onstrates improved flow of contrast agent through the left innominate vein.

Reference

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