Juvenile Open-Angle Glaucoma: A Case Comparison

Nova Southeastern University, Davie, Florida, USA

Introduction. Juvenile open-angle glaucoma typically occurs between the ages of 5 to 35 and patients are often asymptomatic with IOP of 30 mmHg or higher. Case Presentation. Comparing and contrasting a classic case of juvenile open-angle glaucoma with an atypical case. Case 1: 13 year old Hispanic female with elevated IOPs, nerve fiber layer defects in the left eye with corresponding visual field defects as well as loss of nerve tissue in the left eye. The patient’s pachymetry proves to be thicker than average and angles are open. Case 2: 15 year old African American female with normal IOPs, abnormal nerve fiber layer defects in the right eye with corresponding loss of nerve tissue. The patient has normal corneal thickness and angles are open. Her visual fields are unreliable in both eyes. Deviation From the Expected. It is very unusual to have normal IOPs in cases of juvenile open-angle glaucoma, thus for case 2 secondary causes must be ruled out. Discussion. Case 1: IOP lowering medications were indicated. The patient will be followed up with IOP checks, visual fields, photos and OCTs. Case 2: Follow-up with repeat visual fields and IOP check. Secondary causes must be ruled out. Consult with pediatric glaucoma ophthalmologist, neuro-ophthalmologist, and patient’s PCP. Consider an MRI for completeness. Conclusion. Juvenile open-angle glaucoma can result in significant visual loss if not caught and treated early. These patients tend to present in a classical manor. When a young patient presents with nerve damage consistent with glaucoma yet normal IOP ranges, secondary causes must be ruled out.