Bilateral intraocular pressure elevation and decrease of facility of aqueous humour outflow as a consequence of regional lymphoedema of head and neck.

Abstract

Aqueous humour drainage to the deep cervical lymphatics has been proven in animal experiments, but there have been no observations of changes in intraocular pressure (IOP) or aqueous humour drainage as a consequence of lymph drainage dysfunction. The history of a patient with non-Hodgkin's lymphoma, who underwent a left-sided radical neck dissection in January 1991, is reported. From the end of 1991 lymphoedema of the head and neck, predominantly on the right side, developed without venous stasis but with significant bilateral IOP elevation and aqueous humour outflow reduction, refract to conventional treatment. Two days after cytostatic treatment the lymphoedema disappeared, and IOP and aqueous humour outflow became normal. Four days later the patient died because of an acute bronchopneumonia. The pathological examination revealed an intact internal jugular venous system, enlarged lymph nodes and, as a consequence of previous irradiation, cicatrization in the right side of the neck. On the left side, there was absence of the internal jugular vein and jugular lymphatic trunk due to previous radical neck dissection. Our case suggests that regional lymphatic stasis and the absence of the collateral drainage to the contralateral side significantly reduces the aqueous humour outflow and leads to a bilateral, secondary IOP elevation.