Clot-induced pupillary block and postoperative reverse pupillary block in Uveitis–Glaucoma–Hyphema syndrome associated with late in-the-bag IOL dislocation

Background Uveitis Glaucoma Hyphema (UGH) syndrome results from chafing between an intraocular implant and anterior chamber structures, and it typically presents with anterior chamber inflammation, elevated intraocular pressure and recurrent microhyphema or hyphema. Herein, we report the case of a patient with atypical presentation: iridocorneal angle closure secondary to a clot-induced pupillary block. The same patient developed reverse pupillary block a few weeks after surgery.Case presentation A 77-year-old Caucasian woman presented with iridocorneal angle closure secondary to a clot induced pupillary block. The bleeding was caused by rubbing between a late in-the-bag dislocated intraocular lens and the iris in pseudoexfoliative syndrome. The diagnosis of UGH was initially delayed due to the unusual presentation. She underwent intraocular lens (IOL) exchange and secondary IOL scleral fixation, and subsequently developed reverse pupillary block. Both pupillary blocks were resolved by laser iridotomy.Conclusions Uveitis Glaucoma Hyphema syndrome can rarely present with pupillary block, particularly in cases caused by late in-the-bag IOL dislocation in pseudoexfoliation syndrome. This case is unusual due to the occurrence of both pupillary block and subsequent reverse pupillary block in the same patient, highlighting the importance of recognizing these uncommon and atypical mechanisms.