When the Blind Eye Gets Red: Bilateral Conjunctivitis in Absolute Glaucoma with Phthisis Bulbi Sinistra

Abstract

Introduction: Glaucoma is one of the leading causes of irreversible blindness worldwide, affecting more than 76 million people globally, with numbers projected to increase. In Indonesia, glaucoma accounts for approximately 13–15% of blindness cases, with many patients presenting at an advanced stage. End-stage glaucoma may progress to phthisis bulbi and is often associated with ocular surface impairment. Conjunctivitis in this setting presents a diagnostic challenge as it may be caused by infectious or non-infectious mechanisms.

Case Report: A patient presented with bilateral red eyes for one week, accompanied by epiphora and foreign body sensation without purulent discharge. Examination revealed advanced glaucoma in the right eye with elevated intraocular pressure, and absolute glaucoma with phthisis bulbi in the left eye with no light perception. Both eyes showed conjunctival hyperemia without signs of acute infection.

Discussion: Conjunctivitis in end-stage glaucoma is often associated with ocular surface disease due to chronic inflammation, tear film instability, and long-term use of topical medications. This condition may mimic infection, requiring careful clinical evaluation to avoid misdiagnosis and inappropriate treatment.

Conclusion: Conjunctivitis in end-stage glaucoma is not always infectious but is frequently part of ocular surface disease. Management should be individualized, focusing on patient comfort and quality of life.