Case Review: Pediatric Glaucoma Diagnosis

Ogul Uner, MD, invites Aristomenis “Aris” Thanos, MD, to review a case of vitreous hemorrhage in a 62-year-old man who presented with sudden painless vision loss and floaters in his right eye. The patient denied any past trauma, had a history of type 2 diabetes and hypertension, and was taking apixaban (Eliquis, Bristol Myers Squibb/Pfizer) for atrial fibrillation. Visual acuity was counting fingers in the affected right eye, there was no relative afferent pupillary defect, and the anterior segment was unremarkable. Dr. Thanos discusses causes of vitreous hemorrhage along with common risk factors and comorbidities. He breaks down acute versus long-term treatment considerations, when to send a patient to surgery, and strategies for at-home care. Ogul Uner, MD Financial disclosure: None Aristomenis Thanos, MD Financial disclosure: None

Sila Bal, MD, MPH, invites Caroline Watson, MD, to review a case of blepharitis in a 64-year-old woman who presented with chronic burning, tearing, irritation, and fluctuating, blurry vision in both eyes. Visual acuity is 20/25 OU, and examination showed an unstable tear film, debris at the lash base, mild lid-margin telangiectasia, capped meibomian glands, collarettes, and trace inferior punctate epithelial erosions. Dr. Watson shares her advice for managing blepharitis and ocular surface disease. She breaks down how to define blepharitis, how its symptoms can overlap with other dry eye conditions, what to ask patients to determine their symptoms’ underlying causes, and how to approach treatment.

Ogul Uner, MD, invites Rehan M. Hussain, MD, to review a case of central serous chorioretinopathy (CSCR) in a 36-year-old man who presented with blurred central vision and distortion in his right eye with no associated pain or photophobia. The patient reported recent personal stress and use of intranasal fluticasone. OCT revealed serous retinal detachment with clear subretinal fluid and retinal pigment epithelium irregularity. Dr. Hussain describes the typical presentation of CSCR and reviews its major risk factors, which include high stress and steroid use. He also discusses acute versus chronic CSCR, where it fits in the pachychoroid spectrum of diseases, and how he would approach imaging and treatment.

Ogul Uner, MD, invites Arsham Sheybani, MD, to review a case of lens-induced glaucoma in an 82-year-old woman who presents with pain, redness, and blurry vision in her left eye. Visual acuity is hand motion, IOP is 48 mm Hg, and an examination revealed a deep anterior chamber with 3+ cells and white particles and a dense, hypermature cataract. Gonioscopy showed an open angle and intact lens capsule. Dr. Sheybani shares his thoughts on the case and describes the presentations of secondary angle-closure and open-angle glaucomas, including phacomorphic, phacoantigenic, and phacolytic glaucomas. He covers differentiating from primary angle-closure and open-angle mechanisms and how to proceed with surgical treatment.

Maura Di Nicola, MD, joins Ogul Uner, MD, to talk about white dot syndromes, a group of inflammatory chorioretinopathies. They begin with a case of a 32-year-old woman who presents with blurry vision in the right eye for 2 weeks, with new onset floaters with mild pain and photophobia. Examination showed 2+ vitreous cells and multiple yellow-white chorioretinal lesions in both eyes. Dr. Di Nicola shares what questions to ask about the patient’s history and what factors to consider when forming a differential diagnosis. Drs. Uner and Di Nicola further discuss the signs of multifocal choroiditis, distinguishing between different presentations of white dot syndrome, and what can be learned from multimodal imaging.

Ogul Uner, MD, invites Amina Malik, MD, to review a case of suspected thyroid eye disease (TED) in a 44-year-old female patient who presents with eye redness and diplopia. The patient reported no recent illnesses or medications, and external examination showed upper eyelid retraction, edema, erythema, and mild chemosis. Dr. Malik shares her initial thoughts on the case and describes the diagnostic features and most common clinical signs of TED. She also reviews treatment approaches for the acute and chronic forms of the disease.

Erick Rivera Grana, MD, meets with host Ogul Uner, MD, to review a case of a 34-year-old woman who experienced blurred vision and mild discomfort in her right eye with an IOP of 38 mm Hg. The patient also presented with conjunctival injection and posterior synechiae. Dr. Rivera Grana describes his diagnostic approach to this case and explains the management of uveitic ocular hypertension and uveitic glaucoma.

Neuro-ophthalmologist Amanda Redfern, MD, joins host Ogul Uner, MD, to review a case in which a 70-year-old woman experienced intermittent visual disturbances and headaches. Examination revealed a relative afferent pupillary defect and optic disc inflammation. Dr. Redfern explains her initial diagnosis of arteritic anterior ischemic optic neuropathy (AAION) and outlines the typical demographics of patients who present with AAION.

Ogul Uner, MD, is joined by vitreoretinal surgeon and uveitis specialist Akshay Thomas, MD, for a comprehensive, case-based discussion on intermediate uveitis and pars planitis. In this case of a young patient presenting with floaters and blurred vision, Dr. Thomas breaks down how to distinguish intermediate uveitis from pars planitis and recognize key exam findings. The conversation highlights the critical role of widefield imaging, OCT, and fluorescein angiography, as well as a thoughtful approach to systemic workup.

Ogul Uner, MD, invites Ta Chen Peter Chang, MD, a pediatric glaucoma specialist, to review a case of a 9-month-old boy who presented with significant photophobia in both eyes. Examination showed IOP of 32 mm Hg in the right eye and 29 mm Hg in the left eye with moderate optic nerve cupping in both eyes. Dr. Chang shares what additional information he would look for to make a diagnosis of pediatric glaucoma. He also shares insights from the Childhood Glaucoma Research Network, a consortium of glaucoma specialists that has developed a consensus of diagnostic criteria.