Unilateral Glaucoma Clinical Presentation
- Author: Ingrid U Scott, MD, MPH; Chief Editor: Hampton Roy, Sr, MD more...
Elicit history of trauma, thyroid disease, congestive heart failure, vasculitis, malignancy, and other systemic diseases.
Diplopia may be a presenting complaint of patients with a carotid-cavernous sinus fistula, thyroid ophthalmopathy, or retrobulbar tumor.
Carotid-cavernous sinus fistulae often present after the following:
A severe head injury
Any penetrating injury to the orbit injuring the medial or inferomedial wall of the orbit and/or the superior orbital fissure
Surgery involving the internal carotid artery
Rupture of a preexisting aneurysm of the internal carotid artery
Increased EVP may cause pulsating exophthalmos, conjunctival chemosis, engorgement of the episcleral vein, restricted ocular motility, ocular bruit, and ocular ischemia.
Dilated episcleral vessels are a prominent feature of Sturge-Weber syndrome; choroidal hemangioma is present in 31-50% of patients with Sturge-Weber syndrome.
A common clinical sign of an orbital varix is intermittent exophthalmos (exophthalmos occurring when the head is placed in a dependent position, when the patient sneezes, or when the patient performs a Valsalva maneuver).
Orbital tumors may cause proptosis and restricted ocular motility.
Thyroid ophthalmopathy may cause proptosis, restricted ocular motility, conjunctival chemosis, epiphora, exposure keratitis, and optic nerve compression.
Presenting signs of the superior vena cava syndrome include edema of the lid, face, and conjunctiva; vascular engorgement of the fundus, episclera, and conjunctiva; proptosis; optic nerve edema; and glaucoma.
IOP may increase while supine and may decrease while sitting.
The most common presenting manifestations of ICE syndrome are iris abnormalities (eg, iris atrophy, corectopia, ectropion uveae, peripheral anterior synechiae, iris nevi), decreased vision, and pain. Other features of the syndrome may include fine-hammered silver appearance of the posterior cornea and corneal edema.
Glaucoma associated with EVP is due to increased resistance of aqueous outflow from the Schlemm canal and is associated with arteriovenous anomalies, venous obstruction, and idiopathic anomalies.
Glaucoma associated with ICE syndrome is believed to be due to trabecular meshwork obstruction caused by peripheral anterior synechiae or, less commonly, an abnormal cellular membrane.
Mansouri K, Sommerhalder J, Shaarawy T. Prospective comparison of ultrasound biomicroscopy and anterior segment optical coherence tomography for evaluation of anterior chamber dimensions in European eyes with primary angle closure. Eye. 2009 May 15. [Medline].
Kitsos G, Zikou AK, Bagli E, Kosta P, Argyropoulou MI. Conventional MRI and magnetization transfer imaging of the brain and optic pathway in primary open-angle glaucoma. Br J Radiol. 2009 May 11. [Medline].
Wittström E, Ponjavic V, Lövestam-Adrian M, Larsson J, Andréasson S. Electrophysiological evaluation and visual outcome in patients with central retinal vein occlusion, primary open-angle glaucoma and neovascular glaucoma. Acta Ophthalmol. 2009 Apr 27. [Medline].
Gandolfi SA, Cimino L, Sangermani C, et al. Improvement of spatial contrast sensitivity threshold after surgical reduction of intraocular pressure in unilateral high-tension glaucoma. Invest Ophthalmol Vis Sci. 2005 Jan. 46(1):197-201. [Medline].
Jain SS, Rao P, Kothari K, et al. Posterior scleritis presenting as unilateral secondary angle-closure glaucoma. Indian J Ophthalmol. 2004 Sep. 52(3):241-4. [Medline].
Kirsch M, Henkes H, Liebig T, et al. Endovascular management of dural carotid-cavernous sinus fistulas in 141 patients. Neuroradiology. 2006 Jul. 48(7):486-90. [Medline].
Spiegel D, Wetzel W, Neuhann T, Stuermer J, Hoeh H, Garcia-Feijoo J, et al. Coexistent primary open-angle glaucoma and cataract: Interim analysis of a trabecular micro-bypass stent and concurrent cataract surgery. Eur J Ophthalmol. 2009 May-Jun. 19(3):393-9. [Medline].
Peeters A, Webers CA, Prins MH, Zeegers MP, Hendrikse F, Schouten JS. Quantifying the effect of intraocular pressure reduction on the occurrence of glaucoma. Acta Ophthalmol. 2009 Apr 27. [Medline].
Albert DM, Jakobiec FA, Azar DT. Glaucoma associated with increased episcleral venous pressure. Principles and Practice of Ophthalmology. 2nd ed. WB Saunders Co; 2000. 2781-2792.
Alvarado JA, Underwood JL, Green WR, et al. Detection of herpes simplex viral DNA in the iridocorneal endothelial syndrome. Arch Ophthalmol. 1994 Dec. 112(12):1601-9. [Medline].
Cibis GW, Tripathi RC, Tripathi BJ. Glaucoma in Sturge-Weber syndrome. Ophthalmology. 1984 Sep. 91(9):1061-71. [Medline].
Font RL, Ferry AP. The phakomatoses. Int Ophthalmol Clin. 1972. 12(1):1-50. [Medline].
Manor RS, Kurz O, Lewitus Z. Intraocular pressure in endocrinological patients with exophthalmos. Ophthalmologica. 1974. 168(4):241-52. [Medline].
Uram M, Zubillaga C. The cutaneous manifestations of Sturge-Weber syndrome. J Clin Neuroophthalmol. 1982 Dec. 2(4):245-8. [Medline].
Watson PG, Hayreh SS. Scleritis and episcleritis. Br J Ophthalmol. 1976 Mar. 60(3):163-91. [Medline].
Weiss DI. Dual origin of glaucoma in encephalotrigeminal haemangiomatosis. Trans Ophthalmol Soc U K. 1973. 93(0):477-93. [Medline].
Suh MH, Yoo BW, Park KH, Kim H, Kim HC. Reproducibility of spectral-domain optical coherence tomography RNFL map for glaucomatous and fellow normal eyes in unilateral glaucoma. J Glaucoma. 2015 Mar. 24 (3):238-44. [Medline].