Case Report Increased Intraocular Pressure after Extensive Conjunctival Removal:

Episcleral venous pressure (EVP) has been reported to be elevated in patients with carotid cavernous sinus fistu-lae, thyroid ophthalmopathy, Sturge-Weber syndrome, oth-er general venous static conditions, and, rarely, in the ab-sence of any identifiable cause [1]. Elevated EVP increases intraocular pressure (IOP) because IOP is determined by the balance between aqueous production rates and the EVP [2-6]. Thus, the cause and extent of EVP elevation needs to be determined. We recently treated a patient with intractably elevated EVP and IOP after extensive removal of bulbar conjunctiva. A deficiency of conjunctival vascu-lature in this patient may have been the cause of the patho-genic EVP elevation, or may have at least aggravated the condition. Case Report A 50-year-old Asian woman who had undergone con-junctival and Tenon’s capsule removal surgery on the right eye for cosmetic purposes at a local clinic 8 months prior to presentation, was referred to our University-associated tertiary-care eye center due to uncontrolled elevated IOP. She did not have any other significant past medical or so-cial history. She did not take any systemic medications. Before conjunctival removal surgery, she had complained of redness in the right eye for 3 years, although she did not have ocular pain or irritation. The left eye did not show redness. Before surgery, IOP measurement was performed at two different visits. Goldmann applanation tonometry revealed that IOPs were 19 and 13 mmHg at the first visit, and 19 and 12 mmHg at the second visit, in the right and left eye, respectively. The optic disc and visual field (VF) were apparently normal. Average retinal nerve fiber layer (RNFL) thickness, determined by Stratus optical coher-ence tomography (OCT), revealed mild asymmetry, the av-erage RNFL thickness was 91.77 microns in the right eye and 103.22 microns in the left (Fig. 1A). Her prior surgery included extensive removal of nasa