Unilateral Glaucoma Treatment & Management
- Author: Ingrid U Scott, MD, MPH; Chief Editor: Hampton Roy, Sr, MD more...
Although topical glaucoma medications and oral carbonic anhydrase inhibitors may be used initially to control IOP, the underlying etiology must be resolved to achieve long-term IOP control.
Medications that decrease aqueous production are more effective than drugs that increase aqueous outflow.
Medications that reduce aqueous production can often control the early stages of glaucoma.
Epinephrine may be effective in some cases.
The benefit of topical prostaglandins remains to be demonstrated.
Miotics are generally ineffective due to mechanical obstruction of the trabecular meshwork.
Laser trabeculoplasty is generally ineffective unless there are secondary changes in the outflow channels.
Glaucoma filtering surgery may be necessary in cases refractory to medical therapy to completely bypass the resistance due to increased EVP; ciliochoroidal effusions or suprachoroidal hemorrhage may complicate filtering surgery.
The optimal treatment of a direct carotid-cavernous sinus fistula is closure of the abnormal arteriovenous communication with preservation of internal carotid artery patency. Techniques to achieve this result include surgical repair of the damaged portion of the intracavernous internal carotid artery, electrothrombosis, embolization, or balloon occlusion of the fistula.
Dural carotid-cavernous sinus fistulae may close spontaneously, but, for those lesions causing progressive or unacceptable symptoms and signs, standard embolization or endovascular balloon occlusion is generally performed. If these techniques are unsuccessful, direct surgery on the cavernous sinus may be considered. In cases where anatomy makes a standard intravascular approach impossible, the superior ophthalmic vein can be cannulated and a balloon or coil can be threaded into the area of a direct communication.[4, 5, 6, 7]
Laser trabeculoplasty is usually ineffective.
Patients with ICE syndrome generally do well with glaucoma filtering surgery, although late failure may develop due to endothelialization of the fistula, which, in some cases, may be reopened with the Nd:YAG laser.
Consultation is indicated depending on the coexisting conditions, as follows:
- Oculoplastic consultation for management of orbital tumors
- Vitreoretinal consultation for management of choroidal hemangiomas
- Patients with thyroid ophthalmopathy may benefit from neuro-ophthalmic and/or oculoplastic consultation for management of optic neuropathy.
- Corneal consultation for management of exposure keratitis
Cornea consultation for management of corneal edema
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