Elevated
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Mateusz Siedlinski, Lorenzo Carnevale, Xiaoguang Xu, Daniela Carnevale, Evangelos Evangelou, Mark J Caulfield, Pasquale Maffia, Joanna Wardlaw, Nilesh J Samani, Maciej Tomaszewski, Giuseppe Lembo, Michael V Holmes, Tomasz J Guzik, Genetic analyses identify brain structures related to cognitive impairment associated with elevated blood pressure, European Heart Journal, 2023;, ehad101,
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Jean Shin used archival photographs of the Second and Third Avenue elevated train to create compositions in ceramic tile, glass mosaic, and laminated glass. The imagery is manipulated and re-configured with each station level having its own focus, palette, and material. As one enters and descends the Third Avenue escalator, the view is filled with ceramic tile depicting construction beams and the cranes that dismantled the El in the 1940s. At the mezzanine, a mosaic reveals the sky where the train had previously been present, and people from that era of neighborhood transformation. The platform level features semi-transparent and reflective glass depicting vintage scenes of the neighborhood, enabling contemporary viewers to see themselves in the cityscape of the past.
Elevated episcleral venous pressure (EVP) is a clinical finding which may be associated with elevated intraocular pressure (IOP) and glaucoma if left chronically untreated. In many cases the diagnosis is secondary to an underlying etiology, however it can also be idiopathic if all other causes are excluded. The idiopathic form can be familial or sporadic. In German literature idiopathic elevated EVP leading to secondary open angle glaucoma has been termed Radius-Maumenee Syndrome[1].
Etiologies can range from venous obstruction to arteriovenous anomalies and can be acute or chronic in nature. It is important to elicit the timing of any trauma and do a full review of systems, including any previous infectious exposures, to rule out life or vision threatening causes of elevated EVP.
Typically, when patients present for evaluation of elevated EVP it is due to chronic eye redness that has not responded to previous treatment and often is misdiagnosed as chronic conjunctivitis[5]. They are usually unaware of their condition or underlying cause and typically do no describe pain or irritation. It is important to ask about recent trauma, specifically craniofacial, that can suggest a carotid cavernous sinus (high flow) or dural (low flow) fistula[5][9]. A complete past medical history should be obtained to rule out etiologies that may cause venous obstruction, including but not limited to hyperthyroidism, amyloidosis, congestive heart failure, hypercoagulable states, vasculitis, superior vena cava syndrome and Sturge-Weber Syndrome.
A complete workout to rule out underlying etiology should be done when elevated EVP is suspected. In the setting of detecting an arteriovenous fistula, cerebral angiography is the gold standard, however orbital Doppler ultrasound is a non-invasive method which can confirm dilation of the superior ophthalmic vein[7]. Other modalities for diagnosis include orbital ultrasound, ultrasound biomicroscopy (UBM), computerized axial tomography and magnetic resonance imaging.
The aim of management should revolve around first treating the primary underlying etiology. If no etiology is determined for the elevated EVP then treatment is similar to that of primary open angle glaucoma (POAG)[13].
Medical therapy is aimed at decreasing aqueous humor production and increasing uveoscleral outflow. Medications that enhance outflow through the conventional pathway are not as effective[7]. Beta blockers and carbonic anhydrase inhibitors are favored in treatment of elevated EVP. Given its action on the arterial vasculature, Apraclonidine ma
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