Unilateral Reverse Pupillary Block Associated with Multiple Ciliary Body Cysts and Pseudoexfoliative Syndrome

TL;DR

A 64-year-old patient developed glaucoma due to a rare eye condition involving ciliary body cysts and pseudoexfoliation, requiring surgery to stabilize eye pressure.

Contribution

This case highlights the diagnostic importance of multimodal imaging in identifying complex glaucoma caused by ciliary body cysts and pseudoexfoliation.

Findings

Bilateral ciliary body cysts were identified, with the left eye showing reverse pupillary block and angle-closure glaucoma.

Trabeculectomy successfully stabilized intraocular pressure and resolved the reverse pupillary block.

The combination of cysts, pseudoexfoliation, and anatomical changes led to secondary glaucoma in the left eye.

Abstract

The aim of this study is to present interesting images of a clinical case of asymmetrical bilateral ciliary body cysts associated with pseudoexfoliative syndrome (PEX), leading to unilateral reverse pupillary block and subsequent secondary angle-closure glaucoma in a 64-year-old patient who presented with vision loss and redness, revealing angle-closure glaucoma in the left eye. Slit lamp examination showed an asymmetrical iris configuration between the eyes, with a normal appearance in the right eye and an inverted “volcano-shape” iris appearance, corresponding to reverse pupillary block, with pseudoexfoliation in the left eye. Multimodal imaging confirmed the presence of bilateral ciliary body cysts, which were unexpectedly identified in the right eye. The patient’s secondary angle-closure glaucoma in the left eye was likely due to anterior displacement of the iris from these cysts. Following an inadequate response to topical and systemic treatments, the patient underwent trabeculectomy in the left eye, successfully stabilizing the intraocular pressure (IOP) and leading to the resolution of the reverse pupillary block. This case underscores the importance of thorough ocular examination and multimodal imaging in diagnosing complex clinical presentations like secondary angle-closure glaucoma stemming from the combination of ciliary body cysts’ pressure towards the angle, the pseudoexfoliative material component, and the reverse pupillary block configuration. All of the findings provided critical diagnostic clues leading to the identification of the underlying pathology.

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