Posner-Schlossman Syndrome 

  • Author: James H Oakman Jr, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: May 10, 2010
 

Background

Glaucomatocyclitic crisis is a condition with self-limited recurrent episodes of markedly elevated intraocular pressure (IOP) with mild idiopathic anterior chamber inflammation. It is most often classified as secondary inflammatory glaucoma.

In 1948, Posner and Schlossman first recognized glaucomatocyclitic crisis and described the features of this syndrome.[1] For this reason, the entity is often termed Posner-Schlossman syndrome (PSS).

Posner and Schlossman identified the following features[2] :

  • Recurrent episodes of mild cyclitis
  • Uniocular involvement
  • Duration of attack varying from a few hours to several weeks
  • Signs of a slight decrease in vision, elevated IOP with open angles, corneal edema with a few keratic precipitates, heterochromia with anisocoria, and a large pupil in the affected eye
  • Normal visual fields
  • Normal optic disc
  • Normal IOP and outflow facility, and all provocative tests normal between episodes

Since this original description, other cases attributed to glaucomatocyclitic crisis have been found to deviate from these criteria.[3] For instance, some patients with glaucomatocyclitic crisis have abnormal aqueous humor dynamics and may have an underlying primary open-angle glaucoma (POAG).[4]

Additional features that are now recognized are as follows:

  • Almost exclusively, this condition affects individuals aged 20-50 years.
  • Both eyes may be involved at different times but very rarely contemporaneously.[5, 6]
  • The rise of IOP is out of proportion to the severity of the uveitis, and this rise in IOP precedes the identifiable inflammatory reaction, often by several days.
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Pathophysiology

Episodic changes in the trabecular meshwork lead to impairment of outflow facility and result in an elevation of IOP. These changes are accompanied by mild intraocular inflammation. In the acute phase of PSS, optic nerve head parameters and retinal flow rates were altered; however, all returned to normal without any permanent damage after resolution of the elevated IOP. Electroretinogram studies in the acute phase demonstrate a selective reduction in the S-cone b-wave.[7]

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Epidemiology

Frequency

United States

Glaucomatocyclitic crisis is a rare condition.

International

In Finland, the incidence is 0.4 and the prevalence is 1.9 per 100,000 population.[8]

Mortality/Morbidity

Prolonged IOP elevation results in damage to the optic nerve head and visual field defects typical of glaucomatous atrophy.[9]

Age

This condition almost exclusively affects individuals aged 20-50 years. However, there are reports of rare episodes in individuals older than 60 years as well as in adolescence.[10]

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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  Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

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

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