The Tense Eye Behind The Haze: A Masquerading Case After Lasik Enhancement

To describe a masquerading case of steroid-induced glaucoma following LASIK enhancement, initially misdiagnosed and repeatedly treated as pseudo–diffuse lamellar keratitis (pseudo-DLK).

Tertiary eye hospital in Baghdad, Iraq.

A young male underwent LASIK enhancement for refractive regression and subsequently developed progressive corneal haze, blurred vision, and severe headache. Intensive topical steroid therapy was initiated, followed by four flap lifts and interface washes (three by the primary surgeon and one by another surgeon), with no clinical improvement.
On presentation to us seeking another opinion, corneal interface haze and reduced visual acuity were noted, with a tense globe on digital palpation despite the use of three intraocular pressure (IOP)–lowering medications. Air-puff tonometry measured an IOP of 22 mmHg. Fundus examination revealed a small optic disc with an inferior notch. Corvis-ST assessment demonstrated true IOP values in the high 30s mmHg, confirming steroid-induced ocular hypertension.
Cessation of steroids and maximal medical therapy were insufficient, and bilateral trabeculectomy was performed one week apart by a glaucoma surgeon upon referral. Postoperatively, headache resolved, visual acuity improved, and corneal clarity was restored that revealed the right eye has inferior flap melt with bilateral epithelial ingrowth. Surgical management included right eye flap amputation and left eye epithelial ingrowth debridement mechanically and with the help of absolute alcohol, reinforced with three 10-0 nylon sutures. A small peripheral recurrence of epithelial ingrowth in the left eye was successfully treated with Nd:YAG laser.

Steroid-induced ocular Hypertension may masquerade as pseudo-DLK after LASIK enhancement, leading to repeated unnecessary interface interventions. Accurate IOP assessment and early glaucoma evaluation are critical to prevent optic nerve damage and corneal complications.