Glaucoma Quiz 4

Lini Bhatia, M.D. | MEEI
Teresa C. Chen, M.D. | MEEI

July 26, 2004

Case History
Case: A 45-year-old white female patient complained of mild pain, mild blurred vision, and rainbows around lights in her right eye. She gives a history of a similar attack in the past. There was minimal conjunctival congestion, a clear cornea, a few cells in the anterior chamber, and several fine keratic precipitates (figure). The intraocular pressure was 46 mm Hg OD, and the angle was open.
Questions and Answers
1. What is your probable diagnosis?
Answer: Posner-Schlossman syndrome (Glaucomatocyclitic crisis)

2. What is the differential diagnosis?
Answer: Inflammatory open-angle glaucoma (esp. viral), acute angle-closure glaucoma, pigmentary glaucoma, Fuch’s heterochromic iridocyclitis, and neovascular glaucoma.

3. How do you differentiate this condition from uveitic glaucoma?

Answer: In uveitic glaucoma, there is usually more discomfort, more conjunctival injection, more cells and flare, and usually signs of past inflammation (e.g. peripheral anterior synechiae, posterior synechiae, etc.).

4. How do you treat the patient?
Answer: Any of the following may be used: topical beta-blockers, topical alpha-agonists, topical or systemic carbonic anhydrase inhibitors, topical corticosteroids, and cycloplegics.

5. Why is the follow-up very important?
Answer: These patients are at high risk for developing chronic open-angle glaucoma and therefore should be watched carefully.