Asymmetric uveal effusion in bilateral nanophthalmos presenting as unilateral secondary angle closure: a rare case report

Purpose To report a rare case of unilateral secondary angle closure in a young male with bilateral nanophthalmos caused by spontaneous supraciliary and choroidal effusion, highlighting the diagnostic role of multimodal imaging and the importance of individualized management.Case report A 33-year-old male, a known case of hyperopia in both eyes, presented with gradual visual loss in both his eyes. Examination revealed asymmetric anterior chamber depth with shallowing in right eye (RE) > left eye (LE), bilateral short axial lengths, and a 360° choroidal detachment in the RE, while the fellow eye remained clinically stable. Ultrasound biomicroscopy (UBM) confirmed supraciliary effusion in the affected eye, explaining the secondary angle closure mechanism.Treatment and outcome Despite initial conservative management with oral & topical steroids, he had persistent choroidal effusion and was advised surgical intervention. He underwent single quadrant posterior sclerostomy, which resulted in significant resolution of effusions with anatomical and visual improvement.Conclusion This case highlights the importance of considering spontaneous supraciliary effusion as a possible cause for unilateral secondary angle closure in short eyes. Underscores the importance of early multimodal imaging and timely posterior sclerostomy to preserve vision when medical therapy is unsuccessful. Asymmetrical angle closure could be a clinical clue to detect uveal effusions in nanophthalmos.