glaucomatocyclitic crisis (Posner-Schlossman Syndrome)

Epidemiology

• adults 20-50 years

Pathology

• self-limited recurrent episodes of markedly elevated intraocular pressure with mild idiopathic anterior chamber inflammation

Clinical manifestations

• recurrent, unilateral red eye with very mild discomfort, or possibly no discomfort at all
• visual acuity will be mildly reduced (often chief complaint)
• cornea will be mildly edematous
• anterior chamber will be remarkably clear
• often, the only signs of anterior chamber inflammation will be a rare cell or two in the chamber or, more commonly, a few keratic precipitates on the endothelium
• increased intraocular pressure with open angles
  • intraocular pressure can range from 30-70mm Hg, but the patient will not be in acute distress
  • elevation of intraocular pressure out of proportion to the severity of the uveitis
• duration of attack vary from a few hours to several weeks
• normal optic disc
• normal intraocular pressure between episodes
• both eyes may be involved at different times, but rarely simultaneously

Diagnostic procedures

• ophthalmoscopy

Management

• lower intraocular pressure
  • ophthalmic agents
    • timolol
    • dorzolamide
    • apraclonidine
  • oral carbonic anydrase inhibitor
• control of inflammation
  • prednisolone acetate ophthalmic 1% QID
  • oral NSAIDs
• surgery
  • indications
    • signs of optic nerve damage
    • visual field changes
• prognosis
  • most patients treated for attacks recover without long-term sequelae
  • patients with repeated attacks may have optic nerve damage or visual field deficits
    • duration & magnitude of elevated intraocular pressure rather than the frequency of attacks is implicated

More general terms

• complication
• open-angle glaucoma (OAG)
• uveitis
• syndrome

Additional terms

• glaucoma