Increased pressure of dilated episcleral veins with open-angle glaucoma without exophthalmos

Six unilateral cases and one bilateral case of dilated episcleral veins with elevated intraocular pressure without exophthalmos are described. Episcleral venous pressure measured on six unilateral cases showed increased pressure in the affected eye compared to the other eye and to normal controls. Two eyes had typical glaucomatous disc and visual field changes. Five had more optic disc cupping and pallor in the eye with the elevated episcleral venous pressure and intraocular pressure. A thorough work-up, including orbital venography in two unilateral cases, carotid arteriography in one and episcleral fluorescein angiography in five cases, failed to show venous obstruction or direct arterio-venous communications. The different diagnoses are discussed. This condition should be considered in unilateral or asymmetrical intraocular pressure elevation and in those patients with chronically red eyes without discharge.