Drug-Induced Glaucoma Clinical Presentation
- Author: Douglas J Rhee, MD; Chief Editor: Hampton Roy, Sr, MD more...
Elicit the patient's current medications, including any recent changes in medications or dietary supplements.
- With steroid-induced glaucoma, the pressure elevation is gradual. Therefore, like primary open-angle glaucoma, very few symptoms exist.
- Visual symptoms of drug-induced acute angle-closure glaucoma are the same as primary acute angle-closure glaucoma.
- Past ocular history/past medical history
- Elicit history of systemic medical disease, which could require chronic corticosteroid use (eg, uveitis, collagen vascular disease, asthma, dermatitis).
- Patients with preexisting primary open-angle glaucoma, a family history of primary open-angle glaucoma, diabetes mellitus, high myopia, or connective tissue diseases are at greater risk to be steroid responders.
Perform a complete ophthalmic examination.
- Vision and refraction - Patients with hyperopia are at an increased risk for narrow angles.
- Pupils - Test for the presence of an afferent pupillary defect if topical use has been unilateral or if the attack has only occurred in one eye.
- External examination - Use a flashlight test to identify an anatomically narrow angle.
- Slit lamp examination - Exclude stigmata of other causes of secondary glaucoma.
- Cornea - Krukenberg spindle (eg, pigmentary glaucoma), keratic precipitates (eg, uveitic glaucoma, Fuchs heterochromic iridocyclitis)
- Anterior chamber - Anterior chamber depth to indicate narrow angle
- Iris - Heterochromia (ie, Fuchs heterochromic iridocyclitis), iris transillumination defects (eg, pseudoexfoliation, pigment dispersion, previous episodes of intermittent angle closure)
- Lens - Pseudoexfoliation material (pseudoexfoliation glaucoma)
- Gonioscopic evaluation - Examine angle anatomy to determine if the angle is at risk for occlusion with dilation.
- Dilated examination - Inspect the optic nerve for glaucomatous optic nerve damage. See Glaucoma, Primary Open Angle for a description of glaucomatous patterns. Dilate after potentially occludable narrow angles or plateau iris has been excluded by gonioscopy.
Drug-induced glaucoma can occur via two mechanisms, as follows: open-angle glaucoma is generally steroid induced, and closed-angle glaucoma is generally from pupillary dilation.
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