Case Report: Vogt–Koyanagi–Harada syndrome complicated by secondary glaucoma: diagnostic insights and mechanistic correlations in uveitic ocular hypertension

Introduction: This case highlights an uncommon presentation of Vogt-Koyanagi-Harada (VKH) syndrome, in which acute angle-closure glaucoma (AACG) served as the initial ocular manifestation. This atypical onset may lead to misdiagnosis as primary angle-closure glaucoma. This report adds to the existing literature by emphasizing the diagnostic value of ciliary body imaging and the mechanistic link between inflammatory ciliary body detachment and secondary angle closure. Case presentation: A 27-year-old woman presented with acute ocular pain, vision loss, and markedly elevated intraocular pressure (IOP). Important clinical findings included conjunctival congestion, corneal edema, medium-depth anterior chambers, and the absence of keratic precipitates or aqueous flare. Ultrasound biomicroscopy revealed a ciliary body detachment, whereas optical coherence tomography revealed multiple serous retinal detachments. The patient was initially misdiagnosed with glaucoma before a revised diagnosis of VKH syndrome-associated secondary AACG was made. Interventions and outcomes: The patient was treated with intravenous methylprednisolone pulse therapy combined with topical corticosteroids, mydriatic agents, and IOP-lowering agents. Visual acuity and IOP gradually improved, and subretinal fluid completely resolved during follow-up. Conclusion: VKH syndrome rarely presents with AACG as the initial manifestation. Awareness of this presentation and careful imaging evaluation are essential to avoid misdiagnosis. Early and aggressive anti-inflammatory therapy remains key to reversing both angle closure and retinal pathology. This case highlights the importance of considering autoimmune uveitis in patients with atypical angle-closure glaucoma.