Young, blind, and illegal: An unusual outcome of juvenile-onset glaucoma in an undocumented person

Juvenile-onset glaucoma (JG) is a rare type of primary open angle glaucoma (POAG), usually diagnosed before the age of 18. Like adult-onset POAG, it presents with high intraocular pressure, optic nerve excavation, and visual field loss, although generally with a more severe, rapid course. Diagnosis of JG is also often made at a late stage, due to its asymptomatic nature and to de-emphasized glaucoma screenings in the younger population. We report the case of a 39-year-old Caribbean Black female with JG who develops an acute absolute monocular hemianopic defect in the late stage of her glaucoma, an unusual outcome in the disease. The case management of the patient is not only complicated by her late presentation for treatment, but also by her socioeconomic and undocumented status. Thus, her fears of revealing her illegal status and potential deportation further prevents her to seek timely health care, and results in early blindness. As we chronicle her disease course over 4 years, we also highlight how immigration policy and lack of emphasis on primary prevention can undermine efforts of the public health care system, particularly for poor, undocumented persons.