Posner-Schlossman Syndrome Medication

  • Author: James H Oakman Jr, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Mar 2, 2012
 

Medication Summary

A combined regimen of a topical NSAID and an antiglaucoma drug is favored. NSAIDs reduce the inflammatory component by inhibiting the production of prostaglandins, and antiglaucoma medications reduce the influx of new aqueous; both these effects rapidly control the IOP. This combination also avoids potential IOP elevations caused by steroids in steroid-responsive patients.

Next

Corticosteroids

Class Summary

Have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

View full drug information

Prednisolone acetate (Pred Forte)

 

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

Previous
Next

Beta-adrenergic blockers

Class Summary

Reduce elevated and normal IOP.

View full drug information

Timolol maleate (Timoptic, Timoptic XE)

 

Criterion standard for ophthalmic beta-blockers. May reduce elevated and normal IOP, with or without glaucoma, by reducing production of aqueous humor or by outflow.

Previous
Next

Alpha-adrenergic agonists

Class Summary

Reduce IOP by reducing the formation of aqueous humor.

View full drug information

Brimonidine (Alphagan)

 

Selective alpha-2 receptor that reduces aqueous humor formation and increases uveoscleral outflow.

Previous
Next

Carbonic anhydrase inhibitors

Class Summary

Carbonic anhydrase is an enzyme found in many tissues of the body, including the eye. Catalyzes a reversible reaction where carbon dioxide becomes hydrated and carbonic acid dehydrated. By slowing the formation of bicarbonate ions with subsequent reduction in sodium and fluid transport, it may inhibit carbonic anhydrase in the ciliary processes of the eye. This effect decreases aqueous humor secretion, reducing IOP.

View full drug information

Dorzolamide hydrochloride (Trusopt)

 

Used concomitantly with other topical ophthalmic drug products to lower IOP. If more than one ophthalmic drug is being used, administer the drugs at least 10 min apart. Reversibly inhibits carbonic anhydrase, reducing hydrogen ion secretion at renal tubule and increasing renal excretion of sodium, potassium bicarbonate, and water to decrease production of aqueous humor.

View full drug information

Acetazolamide (Diamox, Diamox Sequels)

 

Inhibits enzyme carbonic anhydrase, reducing rate of aqueous humor formation, which, in turn, reduces IOP. Used for adjunctive treatment of chronic simple (open-angle) glaucoma and secondary glaucoma and preoperatively in acute angle-closure glaucoma when delay of surgery desired to lower IOP.

Previous
Next

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Class Summary

Have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known but may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms also may exist, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.

View full drug information

Diclofenac ophthalmic (Voltaren)

 

Inhibits prostaglandin synthesis by decreasing activity of enzyme cyclooxygenase, which, in turn, decreases formation of prostaglandin precursors. May facilitate outflow of aqueous humor and decrease vascular permeability. Any equivalent topical NSAID also can be used.

View full drug information

Indomethacin (Indocin)

 

Rapidly absorbed; metabolism occurs in liver by demethylation, deacetylation, and glucuronide conjugation; inhibits prostaglandin synthesis.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

James H Oakman Jr, MD  Partner, Southern Eye Center, Augusta, Georgia

James H Oakman Jr, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Association of American Physicians and Surgeons, Georgia Medical Society, Georgia Society of General Surgeons, and Georgia Society of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Andrew I Rabinowitz, MD  Consulting Staff, Department of Ophthalmology, Barnet Dulaney Perkins Eye Center

Andrew I Rabinowitz, MD is a member of the following medical societies: Aerospace Medical Association, American Academy of Ophthalmology, and American Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Martin B Wax, MD  Clinical Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Ophthalmology Research and Development, Head, Ophthalmology Discovery Research, Alcon Labs, Inc

Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Society for Neuroscience

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Posner A, Schlossman A. Syndrome of unilateral recurrent attacks of glaucoma with cyclitic symptoms. Arch Ophthalmol. 1948;39:517.

  2. Posner A, Schlossman A. Further observations on the syndrome of glaucomatocyclitic crisis. Trans Am Acad Ophthalmol Otolaryngol. 1953;57:531.

  3. Theodore FH. Observations on glaucomatocyclitic crisis. Br J Ophthalmol. 1952;36:207.

  4. Kass MA, Becker B, Kolker AE. Glaucomatocyclitic crisis and primary open-angle glaucoma. Am J Ophthalmol. Apr 1973;75(4):668-73. [Medline].

  5. Levatin P. Glaucomatocyclitic crisis occurring in both eyes. Am J Ophthalmol. 1956;41:1056.

  6. Dinakaran S, Kayarkar V. Trabeculectomy in the management of Posner-Schlossman syndrome. Ophthalmic Surg Lasers. Jul-Aug 2002;33(4):321-2. [Medline].

  7. Maeda H, Nakamura M, Negi A. Selective reduction of the S-cone component of the electroretinogram in Posner-Schlossman syndrome. Eye. Apr 2001;15:163-7. [Medline].

  8. Paivonsalo-Hietanen T, Tuominen J, Vaahtoranta-Lehtonen H, et al. Incidence and prevalence of different uveitis entities in Finland. Acta Ophthalmol Scand. Feb 1997;75(1):76-81. [Medline].

  9. Darchuk V, Sampaolesi J, Mato L, et al. Optic nerve head behavior in Posner-Schlossman syndrome. Int Ophthalmol. 2001;23(4-6):373-9. [Medline].

  10. Burnstein Y, Shelton K, Higginbotham EJ. Glaucomatocyclitic crisis in a child. Am J Ophthalmol. Jul 1998;126(1):136-7. [Medline].

  11. Pillai CT, Dua HS, Azuara-Blanco A, et al. Evaluation of corneal endothelium and keratic precipitates by specular microscopy in anterior uveitis. Br J Ophthalmol. Dec 2000;84(12):1367-71. [Medline].

  12. Takusagawa HL, Liu Y, Wiggs JL. Infectious theories of Posner-Schlossman syndrome. Int Ophthalmol Clin. Fall 2011;51(4):105-15. [Medline].

  13. Bloch-Michel E, Dussaix E, Cerqueti P, et al. Possible role of cytomegalovirus infection in the etiology of the Posner-Schlossmann syndrome. Int Ophthalmol. Dec 1987;11(2):95-6. [Medline].

  14. Teoh SB, Thean L, Koay E. Cytomegalovirus in aetiology of Posner-Schlossman syndrome: evidence from quantitative polymerase chain reaction. Eye. Dec 2005;19(12):1338-40. [Medline].

  15. Chee SP, Bacsal K, Jap A, Se-Thoe SY, Cheng CL, Tan BH. Clinical features of cytomegalovirus anterior uveitis in immunocompetent patients. Am J Ophthalmol. May 2008;145(5):834-40. [Medline].

  16. Yang SY, Chen MJ, Chen KH, Li AF, Chou CK, Lee SM. Cytomegalovirus and herpes simplex virus as causes of bilateral anterior uveitis in an immunocompetent patient. J Chin Med Assoc. Jan 2011;74(1):48-50. [Medline].

  17. Yamamoto S, Pavan-Langston D, Tada R, et al. Possible role of herpes simplex virus in the origin of Posner-Schlossman syndrome. Am J Ophthalmol. Jun 1995;119(6):796-8. [Medline].

  18. Choi CY, Kim MS, Kim JM, Park SH, Park KH, Hong C. Association between Helicobacter pylori infection and Posner-Schlossman syndrome. Eye (Lond). Jan 2010;24(1):64-9. [Medline].

  19. Nagataki S, Mishima J. Aqueous humor dynamics in glaucomatocyclitic crisis. Invest Ophthalmol. 1976;15:365.

  20. Masuda K, Izawa Y, Mishima S. Prostaglandins and glaucomatocyclitic crisis. Jpn J Ophthalmol. 1975;19:368.

  21. Neufeld AH, Sears ML. Prostaglandin and eye. Prostaglandins. Aug 1973;4(2):157-75. [Medline].

  22. Eakins KE. Increased intraocular pressure produced by prostaglandins E1 and E2 in the cat eye. Exp Eye Res. Jul 1970;10(1):87-92. [Medline].

  23. Jap A, Sivakumar M, Chee SP. Is Posner Schlossman syndrome benign?. Ophthalmology. May 2001;108(5):913-8. [Medline].

  24. Hirose S, Ohno S, Matsuda H. HLA-Bw54 and glaucomatocyclitic crisis. Arch Ophthalmol. Dec 1985;103(12):1837-9. [Medline].

  25. Knox DL. Glaucomatocyclitic crises and systemic disease: peptic ulcer, other gastrointestinal disorders, allergy and stress. Trans Am Ophthalmol Soc. 1988;86:473-95. [Medline].

  26. Kim R, Van Stavern G, Juzych M. Nonarteritic anterior ischemic optic neuropathy associated with acute glaucoma secondary to Posner-Schlossman syndrome. Arch Ophthalmol. Jan 2003;121(1):127-8. [Medline].

  27. Irak I, Katz BJ, Zabriskie NA, et al. Posner-Schlossman syndrome and nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol. Dec 2003;23(4):264-7. [Medline].

  28. Roberts DK, Lukic AS, Yang Y, Moroi SE, Wilensky JT, Wernick MN. Novel observations and potential applications using digital infrared iris imaging. Ophthalmic Surg Lasers Imaging. Mar-Apr 2009;40(2):207-16. [Medline].

  29. Hung PT, Chang JM. Treatment of glaucomatocyclitic crises. Am J Ophthalmol. Feb 1974;77(2):169-72. [Medline].

  30. Varma R, Katz LJ, Spaeth GL. Surgical treatment of acute glaucomatocyclitic crisis in a patient with primary open-angle glaucoma. Am J Ophthalmol. Jan 15 1988;105(1):99-100. [Medline].

  31. Wong PC, Ruderman JM, Krupin T, et al. 5-Fluorouracil after primary combined filtration surgery. Am J Ophthalmol. Feb 15 1994;117(2):149-54. [Medline].

  32. Albert DM, Jakobiec FA. Principles and Practice of Ophthalmology. Vol 3. Philadelphia: Saunders; 1994:1426-35.

  33. de Roetth A Jr. Glaucomatocyclitic crisis. Am J Ophthalmol. Mar 1970;69(3):370-1. [Medline].

  34. Fiore PM. Inflammatory glaucoma. In: Albert DM, Jakobiec FA, eds. Principles and Practice of Ophthalmology. Vol 3. 1994:1426-35.

  35. Grant WM. Clinical measurements of aqueous outflow. Arch Ophthalmol. 1951;46:113.

  36. Hahn IH, Stillman MC. A case of glaucomatocyclitic crisis in the emergency department. Ann Emerg Med. Feb 2006;47(2):167-9. [Medline].

  37. Harstad HK, Ringvold A. Glaucomatocyclitic crises (Posner-Schlossman syndrome). A case report. Acta Ophthalmol (Copenh). Apr 1986;64(2):146-51. [Medline].

  38. Hart CT, Weatherill JR. Gonioscopy and tonography in glaucomatocyclitic crises. Br J Ophthalmol. Sep 1968;52(9):682-7. [Medline].

  39. Hollowich F. Clinical aspects and therapy of the Posner-Schlossman syndrome. Klin Monatsbl Augenheilkd. 1978;172:336.

  40. Hoskins HD, Kass MA. Secondary open-angle glaucoma. Diagnosis and therapy of the glaucomas. 1989;332-4.

  41. Krupin T, Feitl ME. Glaucoma associated with uveitis. In: The Glaucomas. 1989:1205-23.

  42. Perdviel G, Raynaud G, Gayard M. Syndrome de Posner-Schlossman et glaucoma. Bull Soc Ophthalmol Fr. 1962;62:611.

  43. Raitta C, Klemetti A. Steroidbelastung bei Posner-Schlossmanschem Syndrom. V Graefes Arch Klin Exp Ophthalmol. 1967;174:66.

  44. Rhee DJ, Rapuano CJ, Belzer TL, et al. Physician Desk Reference for Ophthalmic Medicines. 2006.

  45. Riatta C, Vannas A. Glaucomatocyclitic crisis. Arch Ophthalmol. 1977;95:608.

  46. Richardson K. Acute glaucoma after trauma. In: Freeman HM, ed. Ocular Trauma. New York: Appleton-Century-Crofts; 1979.

  47. Ritch R, Shields MB, Krupin T. The Glaucomas. St. Louis: Mosby; 1989:1205-23.

  48. Shields MB. Glaucomas associated with ocular inflammation. In: Textbook of Glaucoma. 1992:356-61.

  49. Spivey BE, Armaly MF. Tonographic findings in glaucomatocyclitic crisis. Am J Ophthalmol. 1963;55:47.

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.