Spontaneous resolution of presumed idiopathic elevated episcleral venous pressure

Purpose: To report a case of presumed idiopathic elevated episcleral venous pressure (EVP) initially requiring medical management. Methods: We present a case report of a 28-year-old white man presenting with eye redness and soreness as a referral to the glaucoma service. He was diagnosed with idiopathic elevated EVP after systematic workup. Results: Unilateral elevated intraocular pressure was detected along with dilated episcleral vessels, mild cupping of optic nerve head, and blood in Schlemm's canal, yet negative angiographic imaging and hypercoagulable labs. Topical antiglaucoma medication normalized intraocular pressure, which then maintained with resolution of episcleral vessel caliper and blood in Schlemm's canal after discontinuation of medication. Conclusions: This is the first reported case of spontaneous resolution of presumed idiopathic elevated EVP, persisting after discontinuation of medical therapy and without surgical intervention.