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Elevated Episcleral Venous Pressure (EVP). Elevated episcleral venous pressure (EVP) is a clinical finding which may be observed in a variety of primary conditions. It can also be idiopathic, although this is a diagnosis of exclusion. In either case, elevated EVP may be associated with elevated intraocular pressure (IOP) and glaucoma. Idiopathic elevated EVP leading to secondary open angle glaucoma is also known as Radius-Maumenee syndrome in German literature.
Average EVP ranges from 8-10 mmHg, although it can transiently elevate with downward displacement of the head. Persistently elevated EVP is a known cause of open-angle glaucoma as it can lead to obstruction of the aqueous drainage into the orbital venous system. If not caught early it can lead to an insidious onset of glaucoma and subsequent vision loss. Idiopathic elevated EVP was first described in 1968 by Thomas Minas and Steven Podos in a case report of a family with two members found to have the condition after ruling out primary entities known to cause secondary elevated EVP.
Any history of head trauma is a risk factor for developing a carotid cavernous sinus, dural fistula or other arteriovenous anomaly which can lead to the development of elevated EVP.
Patients with elevated EVP may be entirely unaware of their condition or the underlying cause. They generally present without typical glaucomatous signs or symptoms early in their disease. Patients may endorse a distant history of craniofacial trauma that might suggest the cause of a carotid cavernous sinus, dural fistula or any other arteriovenous anomaly. It is important to review the patient’s medical history, particularly for conditions such as amyloidosis, hyperthyroidism, congestive heart failure, hypercoagulable states, vasculitis, superior vena cava syndrome, Sturge–Weber syndrome, or other arteriovenous anomalies which may suggest an underlying cause for the elevated EVP.
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