Bilateral Episcleral Corkscrew Vessels: Expedition into the Unknown - Case Report

Area of Science:

• Ophthalmology
• Vascular Medicine

Background:

• Idiopathic elevated episcleral venous pressure (IEEVP) is a rare condition characterized by increased venous pressure in the episcleral vessels.
• Diagnosis can be challenging, particularly when ocular hypertension is present without concurrent glaucomatous optic nerve damage.

Observation:

• A 66-year-old woman presented with chronic bilateral red eyes.
• Clinical examination revealed bilateral episcleral vessel engorgement and tortuosity, with elevated intraocular pressure and open iridocorneal angles.
• Despite elevated intraocular pressure, structural and functional tests confirmed the absence of glaucomatous neuropathy.

Findings:

• Systemic workup was unremarkable.
• Magnetic resonance angiography showed bilateral dilated superior ophthalmic veins.
• Cerebral digital subtraction angiography ruled out carotid-cavernous fistula and other significant vascular abnormalities, leading to a diagnosis of IEEVP.

Implications:

• This case underscores the importance of a systematic diagnostic approach for bilateral episcleral vessel engorgement and tortuosity.
• It highlights the need to consider IEEVP in the differential diagnosis, even in atypical presentations with ocular hypertension but no glaucomatous damage.
• Awareness of IEEVP is crucial for clinicians to avoid misdiagnosis and to rule out potentially life-threatening vascular causes.