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case report on pt with uvitic glaucoma pptx
1. UVEITIS AND ELEVATED PRESSURE
• Glaucomatocyclitic crisis
• Fuchs heterochromic iridocyclitis
• Herpes zoster or simplex-associated uveitis
• Phacolytic and/or phacoantigenic glaucoma
• Ciliary body inflammation and rotation with angle closure
glaucoma
2. • Uveitis encompasses a large, diverse group of conditions, many of which
are accompanied by IOP at some point in their clinical course.
• In a particular patient with uveitis, the IOP may range from
• quite low to very high, because inflammation decreases both
– the rate of aqueous humor formation and
– the ease of aqueous humor exit from the eye.
3. Cont…
• The major causes of impaired outflow and thus elevated pressure are as follows:
– Temporary blockage of trabecular meshwork by inflammatory debris
– Peripheral anterior synechiae (PAS) formation related to organization of
debris in
– the angle and gradual incorporation of the iris
– Appositional and then synechial angle closure caused by pupillary block from
– posterior synechiae formation
– Steroid-induced pressure elevation related to the treatment of ocular
inflammation
4. • What is the goals of the evaluating of patients with uveitis and
elevated pressure ?
– Recognizing Particular Uveitis/Glaucoma Syndromes
– to recognize those patients who have one of the chronic uveitis
syndromes, most commonly
• sarcoidosis or
• juvenile idiopathic arthritis, so that their care can be planned for
the long term from the outset.
5. Recognizing Particular Uveitis/Glaucoma
Syndromes
Glaucomatocyclitic Crisis
• Typically presents as an acute unilateral pressure elevation associated with
mild inflammation.
• The patient's complaints relate to
– corneal edema – either blurring or halo vision.
– Pressures often reach the range of 40 to 55 mmHg, and
– the anterior chamber has a modest cellular response with little or no
flare.
– The eye is not red.
– Keratic precipitates may be absent initially but usually develop within a
few days,
• The usual error in diagnosis is to attribute the signs and symptoms to acute
angle closure.
6. Cont…
• Gonioscopy of both the involved eye and the opposite eye differentiates the
two.
• when the anterior segment appearance resembles idiopathic iridocyclitis. A
distinguishing feature is the lack of posterior synechiae in glaucomatocyclitic
crisis.
Editor's Notes
Most patients with nontraumatic uveitis and elevated pressure have either idiopathic inflammation or a recognized syndrome that is managed in largely the same manner as idiopathic uveitis.
Posner-Schlossman Syndrome (PSS), also known as glaucomatocyclitic crisis, is a disease typified by acute, unilateral, recurrent attacks of elevated intraocular pressure (IOP) accompanied by mild anterior chamber inflammation. The pathophysiology is still unknown, although there are several theories proposed, ranging from autoimmune to infectious. Treatment management is focused on controlling the intraocular pressure and decreasing inflammation. While an attack usually resolves without sequelae, repeated attacks over time may lead to long-term glaucomatous damage (a secondary glaucoma).
https://eyewiki.aao.org/Glaucomatocyclitic_Crisis_(Posner-Schlossman_Syndrome)#:~:text=Posner%20and%20Schlossman,and%20optic%20discs
Posner and Schlossman first reported a series of 9 cases and coined the term “glaucomatocyclitic crisis” in 1948.[1] These patients suffered from recurrent unilateral attacks of ocular hypertension that shared the following characteristics:[2]
Unilateral
Recurrent
Mild discomfort or blurring of vision
Increased IOP with open angles
Mild anterior chamber reaction or fine white keratic precipitates (KP)
Crises lasting from several hours to weeks
Normal IOP and no signs of uveitis between attacks
Normal visual fields and optic discs
Glaucomatocyclitic crises resolve spontaneously within a few weeks, with or without treatment. They often recur, and, although generally unilateral at any given episode, they may develop in both eyes. Both cupping and field loss may develop with recurrent or prolonged episodes. Patients with a typical history and typical physical findings do not need uveitis workups. Treat each episode with suppressants of aqueous humor formation. Corticosteroids are generally not necessary.
