Rubeotic glaucoma and what else should be worried about?
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Rubeotic glaucoma and what else should be worried about? Reena Kumari • Ummesara Zishan Mackenzie James • Kuffova´ Lucia
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Received: 12 January 2012 / Accepted: 6 July 2012 / Published online: 29 August 2012 Ó Springer Science+Business Media B.V. 2012
Rubeotic glaucoma and what else should be worried about? A 88 year old man presented to eye casualty with increasing pain in the right eye (RE) over the last week followed by popping sensation, discharge and easing pain. He was blind in the RE due to previous centralretinal-vein-occlusion. The RE also had rubeotic glaucoma with mean intraocular pressure of 30 mmHg. This was being treated with oral acetazolamide, topical beta-blocker (0.5 % Timolol) and topical steroid for 10 years. He had a previous uncomplicated extra-capsular-cataract-extraction and a one piece rigid polymethylmethacrylate (PMMA) intraocular lens was inserted in this eye. His left eye was eviscerated secondary to painful blind eye 13 years ago. On examination erythema of the lids were noted. The conjunctiva was chemotic and haemorrhagic with extrusion of uveal content from a dehiscence extending from the superior/limbal sclera which appeared to be necrotic (Fig. 1). Evisceration was performed as an emergency procedure. Pathological examination revealed severe, focal neutrophil infiltration of the conjunctiva, uvea and sclera with signs of necrosis (Fig. 2) suggesting high possibility of spontaneous R. Kumari (&) U. Zishan M. James K. Lucia Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK e-mail: [email protected]
globe rupture secondary to suppurative sclerokeratitis associated with bullous keratopathy.
Comment Globe rupture is usually a consequence of trauma/ injury. However, there are scattered reports of spontaneous globe rupture in association with systemic disease such as osteogenesis imperfecta, [1]. It has been rarely reported in cases of uncontrolled glaucoma. The mechanism of rupture was thought to be due to sudden and severe increase in intraocular pressure secondary to intravitreal or choroidal haemorrhage [2]. Spontaneous globe rupture has also been reported in context of previous penetrating eye injury [3] or secondary to severe orbital cellulitis [4]. To our knowledge, there are no reports of spontaneous globe rupture in uncontrolled rubeotic glaucoma due to suppurative sclerokeratitis. In the present case, the longstanding keratopathy may have led to epithelial breakdown with secondary suppurative keratitis resulting in weakening of the previous corneo-scleral wound, which gave way. The history of ocular pain in the week prior to presentation would support the diagnosis of an infective necrotising sclerokeratitis and has been recognised as a late post-operative complication [5] even in uncomplicated cases. This is the first reported case of its kind and emphasizes the importance to look for any weak spots if the patient is coming for routine check up.
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Int Ophthalmol (2012) 32:461–462
References 1. Pirouzian A, O’Halloran H, Scher C, J
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