Angle-closure glaucoma in a patient with systemic lupus erythematosus

Abstract

A patient is described known with ITP, who developed an attack of angle-closure glaucoma secondary to posterior scleritis. This condition reacted well to corticosteroid treatment and antiglaucomaleus therapy serologically SLE was highly probable. In fundo there was the picture of a central retinal vein occlusion. Later the patient developed neovascularisation of the optic disc, which did not diminish after panretinal photocoagulation. In spite of cryocoagulation, a vitreous haemorrhage resulted.

Panscleritis masquerading as an attack of primary acute angle closure glaucoma

“…However, secondary angle closure glaucoma in scleritis is uncommon but not unknown [4], [5], [6], [7], [8]. It is seen usually following posterior scleritis (non-pupillary block mechanism), but may also be caused by pupillary block [9].…”

“…Wagemans and Bos [7] reported a 21-year-old female with thrombotic thrombocytopenic purpura and suspected systemic lupus erythematosus who developed angle closure secondary to posterior scleritis with exudative retinal detachment. She had central retinal venous occlusion and the outcome of pars plana vitrectomy with epiretinal membrane peeling and silicone oil for vitreous hemorrhage was dismal with the final visual acuity of light perception [7].…”

“…She had central retinal venous occlusion and the outcome of pars plana vitrectomy with epiretinal membrane peeling and silicone oil for vitreous hemorrhage was dismal with the final visual acuity of light perception [7]. Mangouritsas and Ulbig reported an 81-year-old female who developed unilateral angle closure glaucoma with exudative choroidal detachment in posterior scleritis [8].…”

Ocular Manifestations in Systemic Lupus Erythematosus

“…The first report of open angle glaucoma in SLE was believed to be a report in 1971; the author speculated that an inflammatory connective tissue disorder such as SLE had occurred within the aqueous outflow channels and resulted in glaucoma, but this can also had been aggravated by systemic corticosteroid [66]. Not only secondary open angle glaucoma can be found in SLE patients, but also angle closure glaucoma secondary to choroidal effusion or posterior scleritis [67,68].…”

Retinal Vein Occlusion and Angle Closure

“…[1][2][3] Furthermore, since the first reports of angle-closure and RVO, 7,8 there have been limited additional data, with a more recent case series of 4 subjects with vascular accidents associated with angle-closure describing only 2 cases of APAC and CRVO. 13 However, both cases had multiple medical problems that are associated with retinal vascular disease and/or angle-closure, including systemic lupus erythematosus, 14 idiopathic thrombocytopenic purpura, systemic hypertension, peripheral arterial disease and chronic osteomyelitis of the spine, 2 and use of oral diazepam for anxiety. 13,15 Hence, any association between APAC and CRVO remains largely putative.…”