Dr. Devika Joshi, J17353, Dr. (Wing Cdr) Mansur Ali Khan, Dr. (Brig) Parthasarathi Moulick, Dr. Gurunadh Satyanarayana Velamakanni
We report an unusual case of glaucoma in a 23 year old male with history of transient episodic bilateral visual loss and use of topical steroids for 6 months duration. At presentation he had best corrected vision of 3/60 and 4/60 , and Intraocular pressure (IOP) of 38 and 36 mm Hg in right and left eye respectively with open angles and advanced glaucomatous optic atrophy in both eyes. Fundus showed microaneurysms and blot haemorrhages in multiple quadrant with delayed AV transit time on FFA. Investigations failed to reveal cause for fundus findings and no thrombogenic factors. Increased IOP persisted on stopping steroids and was brought under control with 4 topical antiglaucoma medications. Microaneurysms resolved on control of pressure. It is postulated this was a case of juvenile glaucoma with accelerated progression due to steroid use. Spikes of IOP rise could have caused bilateral transient Central Retinal Vein Occlusions accounting for the microaneurysms and haemorrhages.