Uveitic Glaucoma

Definition:

Uveitic glaucoma is a glaucoma that occurs directly or indirectly as a complication of anterior or chronic uveitis. This glaucoma caused due to uveitis is called secondary glaucoma.

Characteristics of Uveitic Glaucoma

Anatomical and physiological changes are similar to primary open angle glaucoma
Overall prevalence of glaucoma after uveitis varies from 10 to 20%
Prevalence of glaucoma is very high i.e. 46% in cases of chronic uveitis
Can affect one or both eyes

Acute or Chronic attack

Acute onset causes:

Rapid onset of inflammation
Obstruction of intertrabecular spaces
Subsequent increased IOP

Chronic onset causes:

Repeated bouts of uveitis
Fibroblastic infiltration
Formation of scar tissue
Obstruction of the anterior chamber angle

Risk factors of Uveitis complicating to Glaucoma

Some of the uveitic individuals are at more risk of developing glaucoma. These include:

Eyes with shallow anterior chamber
Syndromes like

Juvenile rheumatoid arthritis (JRA)
Fuchs heterochromic iridocyclitis (FHI)
Posner-Schlossman syndrome
Herpetic uveitis
Ankylosing spondylitis
Sarcoidosis

How can Uveitis cause Glaucoma?

Uveitis can lead to glaucoma due to any of the following:

Corticosteroid treatment of uveitis can lead to elevated intraocular pressure (IOP) and its persistent rise can lead to glaucomatous optic neuropathy and visual field loss
Obstruction of trabecular meshwork by inflammatory debris of uveitis can cause increased IOP resulting in decreased fluid outflow from the eye
Chronic inflammation of uveitis can result in obstruction of fluid outflow die to scar tissue formation
Secondary to open angle or angle closure mechanisms

Symptoms of Uveitic Glaucoma

Along with the usual symptoms of uveitis, the glaucoma caused by uveitis may show following symptoms in the patient:

Blurred vision
Blind areas in the ‘side vision’
Severe eye pain associated with corneal edema
Brow ache due to referred pain from eye
Photophobia
Coloured halos
Occasionally, abdominal pain and nausea

Diagnosis of Uveitic Glaucoma

Diagnosis of uveitic glaucoma requires thorough eye examination along with following diagnostic tests:

Slit lamp examination
Measurement of intraocular pressure
Gonioscopy
Fundus examination

In addition to eye examinations, systemic workup, focusing on arthritis, infections, mucosa or skin lesions, and cough should also be conducted. If any other disorder is suspected, it should also be evaluated with respective examinations.

Treatment of Uveitic Glaucoma

Management of uveitic glaucoma typically depends upon its etiology. First of all it involves lowering of elevated IOP followed by medical and surgical therapy to fully treat the uveitis glaucoma. Treatment may include:

IOP lowering drugs
Corticosteroids eye drops or injections
Cycloplegics
Immunosuppressive agents like antimetabolites, T-cell suppressors, and cytotoxic agents
Antimetabolites like Methotrexate, Mycophenolate mofetil
T-cell Suppressors like Cyclosporine
Cytotoxic Agents like Cyclophosphamide, Chlorambucil
Antibiotics
Anti-viral drugs
Cases that cannot be controlled medically, surgical treatment to place a glaucoma drainage device is done to treat uveitic glaucoma
Refractory cases may need anti-glaucoma medications, surgical management, or cyclodestructive laser treatment