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46RELATO DE CASO<br />
Hipertensão venosa episcleral idiopática<br />
unilateral em mulher jovem<br />
Unilateral idiopathic elevated episcleral<br />
venous pressure <strong>in</strong> a young woman<br />
Marcelo Men<strong>de</strong>s Lavezzo¹, Alan Kar<strong>de</strong>c Barreira Junior 1 , Ricardo Suzuki 1 , Rober<strong>to</strong> Freire Santiago Malta 1<br />
RESUMO<br />
O objetivo é relatar o caso <strong>de</strong> uma paciente <strong>de</strong> 33 anos, que veio ao Pron<strong>to</strong> Socorro <strong>de</strong> Oftalmologia apresentando queixa <strong>de</strong> redução<br />
da acuida<strong>de</strong> visual à esquerda, <strong>de</strong> caráter <strong>in</strong>sidioso e progressivo, há dois anos. Ao exame oftalmológico, apresentava <strong>in</strong>gurgitamen<strong>to</strong><br />
dos vasos da conjuntiva bulbar, pressão <strong>in</strong>traocular mui<strong>to</strong> elevada e nervo óptico com escavação <strong>to</strong>tal à esquerda. Foi submetida à<br />
campimetria computadorizada 24:2 WW e SITA-SWAP do olho direi<strong>to</strong>, ambas com resultados <strong>de</strong>ntro da normalida<strong>de</strong>. As <strong>to</strong>mografias<br />
<strong>de</strong> crânio e órbitas, bem como ultrassonografia com doppler do globo ocular, artérias oftálmicas e veias supraorbitárias não<br />
apresentavam anormalida<strong>de</strong>s. Diante disso, aven<strong>to</strong>u-se a hipótese diagnóstica <strong>de</strong> hipertensão venosa episcleral idiopática, um<br />
diagnóstico <strong>de</strong> exclusão, vis<strong>to</strong> que pa<strong>to</strong>logias <strong>in</strong>tracranianas e <strong>in</strong>traorbitárias haviam sido excluídas. Paciente foi tratada cl<strong>in</strong>icamente<br />
com colírios hipotensores, com redução importante da pressão <strong>in</strong>traocular à esquerda, porém não o suficiente, evolu<strong>in</strong>do para<br />
trabeculec<strong>to</strong>mia.<br />
Descri<strong>to</strong>res: Glaucoma <strong>de</strong> ângulo aber<strong>to</strong>; Pressão <strong>in</strong>traocular; Pressão venosa episcleral; Ultrassonografia, doppler; Rela<strong>to</strong>s <strong>de</strong><br />
casos<br />
ABSTRACT<br />
The objective is <strong>to</strong> report a 33 year old female who came <strong>to</strong> the emergency room of Ophthalmology compla<strong>in</strong><strong>in</strong>g of reduced visual acuity<br />
on the left eye, <strong>in</strong> a progressive and <strong>in</strong>sidious way, about two years ago. In the ophthalmological exam<strong>in</strong>ation, she presented dilated<br />
<strong>to</strong>rtuous vessels <strong>in</strong> her left bulbar conjunctiva, very high <strong>in</strong>traocular pressure and <strong>in</strong>creased cupp<strong>in</strong>g of the optic disc. SITA-SWAP and<br />
24:2 computed perimetry were performed on the right eye, both with<strong>in</strong> normal limits. CT scans of the skull and orbits, and ultrasonography<br />
of the eyeball and doppler of the ophthalmic artery and the supra-orbital ve<strong>in</strong>s had no abnormalities. Thus, it was suggested the possibility<br />
of idiopathic elevated episcleral venous pressure, an exclusion diagnosis, s<strong>in</strong>ce <strong>in</strong>tra-cranial and <strong>in</strong>traorbital pathologies were exclu<strong>de</strong>d.<br />
The patient was treated medically with hypotensive eyedrops, with significant reduction of <strong>in</strong>traocular pressure on the left eye, but not<br />
enough, evolv<strong>in</strong>g <strong>to</strong> trabeculec<strong>to</strong>my.<br />
Keywords: Glaucoma, Open-angle; Intraocular pressure; Episcleral venous pressure; Ultrasonography, doppler; Case reports<br />
¹Clínica Oftalmológica do Hospital das Clínicas da Faculda<strong>de</strong> <strong>de</strong> Medic<strong>in</strong>a da Universida<strong>de</strong> <strong>de</strong> São Paulo (HC–FMUSP) – São Paulo (SP) –<br />
Brasil.<br />
Trabalho realizado jun<strong>to</strong> à Clínica Oftalmológica do Hospital das Clínicas da Faculda<strong>de</strong> <strong>de</strong> Medic<strong>in</strong>a da Universida<strong>de</strong> <strong>de</strong> São Paulo (HC–FMUSP)<br />
– São Paulo (SP) – Brasil.<br />
Os au<strong>to</strong>res <strong>de</strong>claram não haver confli<strong>to</strong>s <strong>de</strong> <strong>in</strong>teresse<br />
Recebido para publicação em: 28/4/2011 - Acei<strong>to</strong> para publicação em: 13/2/2012<br />
Rev Bras Oftalmol. 2013; 72 (1): 46-9