[Atypical unilateral glaucoma in a young patient]

Diagnostic and therapeutic problems are common in cases of unilateral optical neuropathy with elevated intraocular pressure (IOP) CASE REPORT: A 17-year-old boy was referred for visual acuity loss and elevated IOP at 40mmHg in his left eye. Juvenile open-angle glaucoma (JOAG) was diagnosed based on the clinical and paraclinical examinations. In spite of a maximal hypotensive treatment, tensional control was insufficient and a filtering surgery procedure was necessary. IOP control was good 6 months after surgery, but functional and anatomical analysis showed neuropathic progression and a bilateralization of the disease.

The diagnosis of JOAG is difficult and sometimes delayed. Secondary bilateralization commonly causes diagnostic problems which can delay specific and appropriate management. Systematic screening should be performed during infancy when a strong family history of glaucoma is known.