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Unilateral Glaucoma Treatment & Management

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

Medical Care

Increased EVP

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.

ICE syndrome

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.

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Surgical Care

Increased EVP

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]

ICE syndrome

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.

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Consultations

Increased EVP

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

ICE syndrome

Cornea consultation for management of corneal edema

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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.

References
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  4. 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].

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