Publication:

Secondary open-angle glaucoma and systemic manifestations in a patient with unrepaired tetralogy of Fallot

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. We report a rare case of secondary open-angle glaucoma in a 20-year-old male with longstanding, uncorrected TOF. The patient presented with 6 months of progressive bilateral vision loss. Ocular examination revealed prominent conjunctival vessel engorgement, elevated intraocular pressure, advanced glaucomatous optic neuropathy with increased cup-to-disc ratios, and significant retinal nerve fiber layer thinning. Notable systemic features included severe digital clubbing, skeletal deformities, congenital ear anomalies with hearing loss, short stature and hypogonadism. Prompt initiation of anti-glaucoma therapy successfully normalized intraocular pressure. This case underscores the importance of routine ophthalmic screening in patients with cyanotic congenital heart disease to detect and manage vision-threatening complications early.