Bilateral Juvenile Open Angle Glaucoma: A Rare Case Report

Juvenile open angle glaucoma (JOAG) is a rare subset of primary open angle glaucoma (POAG) that appears later in childhood or early adulthood. We report a case of 16 year-old girl with progressive vision diminution of both eye (BE) presenting with no perception of light in right eye (RE) and only perception of light in left eye (LE). There was no other ocular or systemic problem. Intraocular pressure (IOP) was 50 mmHg in each eye. There was wide open angle configuration of anterior chamber in BE on gonioscopy. Dilated fundus examination revealed pale optic disc with near total cupping in RE& 0.8 - 0.9 cupping in LE. Thinning of the neuroretinal rim, nasal shifting and bayoneting of the blood vessels were noted in BE. Maximal medical therapy was administered to lower the IOP, with minimal success. Subsequently, Trabeculectomy with topical antimetabolite was performed in left eye, with adequate control of her IOP. Postoperatively, her vision on left eye improved up to hand movement positive. Conclusion- Rarity of the disease and delay in diagnosis often leads to advanced glaucomatous damage of the optic nerve. Hence, IOP measurement must be done as a part of routine ophthalmic examination to overcome the disease burden.