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Unilateral Glaucoma Clinical Presentation

  • Author: Ingrid U Scott, MD, MPH; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Oct 14, 2015
 

History

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
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Physical

Ophthalmic examination

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.

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Causes

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.

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Contributor Information and Disclosures
Author

Ingrid U Scott, MD, MPH Professor, Department of Ophthalmology and Public Health Sciences, Pennsylvania State University College of Medicine

Ingrid U Scott, MD, MPH is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Society of Retina Specialists, Macula Society, Retina Society, American Medical Association, American Society of Cataract and Refractive Surgery, Phi Beta Kappa

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.

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