Idiopathic elevated episcleral venous pressure in a teenager

PURPOSE: To report a case of unilateral idiopathic elevated episcleral venous pressure (IEEVP) in a 15-year-old patient. We reviewed and summarized published case reports of IEEVP to determine how to manage this challenging and rare condition. OBSERVATIONS: A 15-year-old Caucasian male presented with elevated intraocular pressures (IOP), blood in Schlemm canal in the left eye, and asymmetric cupping with corresponding glaucomatous findings on testing. We diagnosed the patient with IEEVP and describe successful surgical intervention with deep sclerectomy and viscocanalostomy. CONCLUSIONS AND IMPORTANCE: IEEVP is a diagnosis of exclusion and based on clinical findings of dilated episcleral veins, blood in Schlemm canal and glaucomatous changes. If glaucomatous progression occurs with medication, filtration surgery is usually required, and most patients have good results in the literature. Care should be taken to prevent post-operative hypotony and serous choroidal detachment.