Angle-closure glaucoma as an initial presentation of systemic lupus erythematosus

Area of Science:

• Ophthalmology
• Rheumatology
• Systemic Autoimmune Diseases

Background:

• Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations.
• Ocular involvement in SLE can be varied, but uveal effusions and secondary glaucoma are less common initial presentations.

Observation:

• A case report detailing a patient presenting with bilateral uveal effusions and angle-closure glaucoma.
• Initial presentation included bilateral pleural effusions and laboratory findings indicative of SLE.
• Ocular examination confirmed bilateral uveal effusions, angle-closure, and elevated intraocular pressures.

Findings:

• Medical and laser therapies were insufficient in controlling the intraocular pressure.
• Surgical interventions, including partial thickness sclerectomies, linear sclerostomies, and choroidal drainage, successfully managed the glaucoma.
• Laboratory results and systemic findings were consistent with a diagnosis of systemic lupus erythematosus.

Implications:

• Uveal effusion with secondary glaucoma can be an early indicator of systemic lupus erythematosus.
• A thorough systemic evaluation is crucial for patients presenting with uveal effusions and secondary angle-closure glaucoma, especially in the absence of prior ocular issues.
• Surgical management involving sclerectomies and choroidal drainage offers a viable treatment option for refractory glaucoma in this context.