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Plateau Iris Glaucoma Clinical Presentation

  • Author: Jim C Wang (王崇安), MD; Chief Editor: Hampton Roy, Sr, MD  more...
Updated: May 06, 2016


Patients with plateau iris tend to be female, in their 30-50s, hyperopic, and often have a family history of angle-closure glaucoma.

Patients may present with angle closure, either spontaneously or after pupillary dilation.

More commonly, the diagnosis of plateau iris configuration is made on routine examination.

Plateau iris syndrome usually is recognized in the postoperative period when the angle remains persistently narrow in an eye after iridotomy.



Slit lamp examination of patients with plateau iris usually shows normal anterior chamber depth with a flat or slightly convex iris surface.

On gonioscopy, the angle is extremely narrowed or closed, with a sharp drop-off of the peripheral iris. When indentation gonioscopy is performed, the double-hump sign is seen. The more peripheral hump is determined by the ciliary body propping up the iris root, and the more central hump represents the central third of the iris resting over the anterior lens surface. The space between the humps represents the space between the ciliary processes and the endpoint of contact of the iris to the anterior lens capsule. More force often is needed to open the angle on indentation gonioscopy than on pupillary block angle closure.

Plateau iris syndrome is characterized by persistent angle occludability (spontaneous, in the dark, or after dilation) in an eye with a patent iridotomy. The level of the iris stroma in relation to the angle structures, referred to as the height of the plateau, differentiates the 2 subtypes of plateau iris syndrome.

In the complete syndrome, the angle is occluded to the upper trabecular meshwork or the Schwalbe line and intraocular pressure (IOP) rises.

Incomplete plateau occludes the angle to mid level, leaving the upper portion of the filtering meshwork open and IOP unchanged. This latter situation is far more common and is clinically important because these patients can develop peripheral anterior synechiae (PAS) and synechial angle closure years after a successful iridotomy. Therefore, patients with open angle after iridotomy should not be assumed to be cured. The angle can narrow further with age, and angle closure can occur years later.



Plateau iris results from large or anteriorly positioned ciliary processes holding forward the peripheral iris and maintaining its apposition to the trabecular meshwork. The etiology underlying this anterior displacement of the pars plicata is unclear but probably represents an anatomic variant.

No indication exists of any abnormality of the ciliary body that would cause such forward rotation of the ciliary processes. The possibility that the lens-zonule apparatus is pulling the process forward is unlikely because of the observation that in pseudophakic patients the iris processes remain in a forward position, despite the posterior position of the posterior chamber lens.

Contributor Information and Disclosures

Jim C Wang (王崇安), MD Vitreo-Retinal and Cornea/Anterior Segment Subspecialist, Department of Ophthalmology, Kaiser Permanente Fontana Medical Center

Jim C Wang (王崇安), MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.


Robert Ritch, MD Shelley and Steven Einhorn Distinguished Chair in Ophthalmology, Chief of Glaucoma Service, Surgeon Director, Professor, Department of Ophthalmology, New York Eye and Ear Infirmary, New York Medical College

Robert Ritch, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Ophthalmological Society, Chinese American Medical Society, International College of Surgeons, New York Academy of Medicine, New York Academy of Sciences

Disclosure: Received none from Sensimed for board membership; Received none from iSonic Medical for board membership; Received consulting fee from Aeon Astron for consulting; Received honoraria from Pfizer for speaking and teaching; Received honoraria from Allergan for speaking and teaching; Received honoraria from Ministry of Health of Kuwait for speaking and teaching; Received honoraria from Aeon Astron for speaking and teaching; Received royalty from Ocular Instruments for other.

Paul S Lee, MD Clinical Assistant Professor, Department of Ophthalmology, Mount Sinai School of Medicine; Chief of Ophthalmology, James J. Peters Veterans Affairs Medical Center; Associate Adjunct Surgeon, New York Eye and Ear Infirmary

Paul S Lee, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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

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

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Bradford Shingleton, MD Assistant Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary

Bradford Shingleton, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology

Disclosure: Nothing to disclose.


Celso Tello, MD Clinical Assistant Professor, Department of Ophthalmology, New York Eye and Ear Infirmary

Celso Tello, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and New York Academy of Sciences

Disclosure: Nothing to disclose.

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Ultrasound biomicroscopy. (A) In plateau iris, the anterior position of the ciliary body holds the peripheral iris against the trabecular meshwork. (B) The angle is obstructed further in the dark as the peripheral iris thickens with physiologic pupillary dilation.
Ultrasound biomicroscopy, plateau iris syndrome. (A) Appositional anterior chamber angle in dark condition prior to laser iridotomy. (B) After laser iridotomy, the angle remains occludable. (C) After peripheral laser iridoplasty, the peripheral iris is thinned, opening the angle and significantly reducing the risk of closure.
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