eMedicine Specialties > Ophthalmology > Intraocular Pressure

Glaucoma, Unilateral: Differential Diagnoses & Workup

Author: Ingrid U Scott, MD, MPH, Professor, Department of Ophthalmology and Public Health Sciences, Penn State College of Medicine
Contributor Information and Disclosures

Updated: Mar 8, 2007

Differential Diagnoses

Glaucoma, Low Tension

Other Problems to Be Considered

Increased EVP

Orbital fractures
Other traumatic injuries
Underlying malignancy
Thyroid disease
Congestive heart failure
Other systemic diseases (eg, spontaneous carotid-cavernous fistulae have been reported in association with Ehlers-Danlos syndrome and pseudoexfoliation)

ICE syndrome

Corneal edema

Workup

Laboratory Studies

  • Lab studies are indicated based on the suspected etiology (eg, thyroid function test, vasculitis workup) of unilateral glaucoma.

Imaging Studies

  • B-scan echography to evaluate for orbital tumor, foreign body, and extraocular muscle enlargement (in thyroid ophthalmopathy and other conditions with EVP); also indicated if fundus cannot be visualized
  • CT scan of orbits to evaluate orbital fracture, foreign body, dilation of superior ophthalmic vein, and enlargement of cavernous sinus (present with carotid-cavernous sinus fistulae)
  • Angiography to evaluate for arteriovenous anomalies
  • Orbital venography to evaluate for orbital varix
  • Color Doppler to evaluate for orbital varix

Other Tests

  • In patients with increased EVP, gonioscopic examination may reveal reflux of blood in the Schlemm canal.
  • Ocular pulse amplitude, as measured by pneumotonometry, is a useful noninvasive tool to evaluate patients with carotid-cavernous fistulae.
  • Malignancy workup for patients with superior vena cava syndrome, orbital tumors
  • Cardiac workup for patients with congestive heart failure

More on Glaucoma, Unilateral

Overview: Glaucoma, Unilateral
Differential Diagnoses & Workup: Glaucoma, Unilateral
Treatment & Medication: Glaucoma, Unilateral
Follow-up: Glaucoma, Unilateral
References

References

  1. Albert DM, Jakobiec FA, Azar DT. Glaucoma associated with increased episcleral venous pressure. In: Principles and Practice of Ophthalmology. 2nd ed. WB Saunders Co;2000: 2781-2792.

  2. Alvarado JA, Underwood JL, Green WR, et al. Detection of herpes simplex viral DNA in the iridocorneal endothelial syndrome. Arch Ophthalmol. Dec 1994;112(12):1601-9. [Medline].

  3. Cibis GW, Tripathi RC, Tripathi BJ. Glaucoma in Sturge-Weber syndrome. Ophthalmology. Sep 1984;91(9):1061-71. [Medline].

  4. Font RL, Ferry AP. The phakomatoses. Int Ophthalmol Clin. 1972;12(1):1-50. [Medline].

  5. 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. Jan 2005;46(1):197-201. [Medline].

  6. Jain SS, Rao P, Kothari K, et al. Posterior scleritis presenting as unilateral secondary angle-closure glaucoma. Indian J Ophthalmol. Sep 2004;52(3):241-4. [Medline].

  7. Kirsch M, Henkes H, Liebig T, et al. Endovascular management of dural carotid-cavernous sinus fistulas in 141 patients. Neuroradiology. Jul 2006;48(7):486-90. [Medline].

  8. Manor RS, Kurz O, Lewitus Z. Intraocular pressure in endocrinological patients with exophthalmos. Ophthalmologica. 1974;168(4):241-52. [Medline].

  9. Uram M, Zubillaga C. The cutaneous manifestations of Sturge-Weber syndrome. J Clin Neuroophthalmol. Dec 1982;2(4):245-8. [Medline].

  10. Watson PG, Hayreh SS. Scleritis and episcleritis. Br J Ophthalmol. Mar 1976;60(3):163-91. [Medline].

  11. Weiss DI. Dual origin of glaucoma in encephalotrigeminal haemangiomatosis. Trans Ophthalmol Soc U K. 1973;93(0):477-93. [Medline].

Further Reading

Keywords

open angle, closed angle, vision loss, visual deficit, open-angle glaucoma, episcleral venous pressure, EVP, glaucoma associated with iridocorneal endothelial syndrome, ICE syndrome

Contributor Information and Disclosures

Author

Ingrid U Scott, MD, MPH, Professor, Department of Ophthalmology and Public Health Sciences, Penn State College of Medicine
Ingrid U Scott, MD, MPH is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Macula Society, Phi Beta Kappa, and Retina Society
Disclosure: Nothing to disclose.

Medical Editor

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 and American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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: Alcon Labs Salary Employment

CME Editor

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.

 
 
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