A case of 'low tension glaucoma' with primary empty sella

Area of Science:

• Ophthalmology
• Neurology
• Radiology

Background:

• Low tension glaucoma (LTG) is a form of glaucoma where optic nerve damage and visual field loss occur despite normal intraocular pressure.
• Primary empty sella (PES) is a condition where the pituitary gland is flattened or herniated into the sella turcica due to a defect in the diaphragma sellae.

Observation:

• A patient presented with characteristic visual field defects and optic disc changes indicative of glaucoma.
• Intraocular pressure measurements were consistently within the normal range.
• Radiological investigations, including X-ray and metrizamide-computed fundography (CF), confirmed the presence of a primary empty sella.

Findings:

• The case demonstrates the simultaneous occurrence of low tension glaucoma and primary empty sella in a single patient.
• The visual and optic disc findings were consistent with glaucoma, while diagnostic imaging confirmed the empty sella.
• This presentation suggests a potential, albeit unproven, association between these two distinct conditions.

Implications:

• The coexistence of LTG and PES may indicate shared underlying pathophysiological mechanisms or a need for comprehensive neuro-ophthalmological evaluation in patients with either condition.
• Further research is needed to explore any potential etiological links or shared risk factors between low tension glaucoma and primary empty sella.
• This case underscores the importance of considering broader neurological and anatomical factors in the diagnosis and management of glaucoma, particularly in atypical presentations.