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Abstract #45794 Published in IGR 13-2
Low flow fistula due to glomus jugulare tumour mimicking graves ophthalmopathy
Garcia A; Jarrin E; Rebolleda G; Munoz-Negrete FJ; Mateos ENeuro-Ophthalmology 2011; 35: 96
AIM: To describe a case of secondary glaucoma due to bilateral epiescleral venous pressure elevation and the diagnostic work-up to establish the aetiology. METHOD: The presence of an acute bilateral caput medusae after a quarrel in a patient with no previous history of vascular or ophthalmological disturbances lead us to perform complete anamnesis, examination and neuroimaging protocol. RESULTS: Intraocular pressure was 30 in his right eye and 26 in his left eye. Episcleral and conjuntictival vessels were dilated and tortuous. The patient did not show exophthalmos, motility disturbances, upper lid retraction nor periorbital bruit. Gonioscopy showed open angle and blood in the Schlemm canal. Laboratory results were normal. MRI and CT showed muscle enlargement suggesting Graves ophthalmopathy. The lack of signs of Graves ophthalmopathy prompted a reconsideration of the diagnosis and new evaluation of the patient with sensitive techniques, such as arteriography, that revealed a glomus jugulare tumour with communication to the jugular vein, cavernous sinus and ophthalmic veins. Conservative treatment was prescribed waiting the surgical decision by the ENT department. CONCLUSIONS: The present case illustrates the differential diagnosis of a bilateral episcleral venous pressure elevation and the importance of neuroimaging in cases of orbital pathology. If an abnormal vascular communication is highly suspected then arteriography may be necessary.
A. Garcia. Department of Ophthalmology, Ramon y Cajal Hospital, Madrid, Spain.
Classification:
2.7 Episcleral veins and venous pressure (Part of: 2 Anatomical structures in glaucoma)
10 Differential diagnosis e.g. anterior and posterior ischemic optic neuropathy
