Posner-Schlossman Syndrome (Glaucomatocyclitic Crisis) Medication

Updated: Jul 07, 2017
  • Author: Leonard K Seibold, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Medication

Medication Summary

A combined regimen of a topical NSAID and antiglaucoma medications is favored. NSAIDs reduce the inflammatory component by inhibiting the production of prostaglandins and antiglaucoma medications reduce the influx of new aqueous; both these effects rapidly control the IOP.

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Nonsteroidal anti-inflammatory drugs (NSAIDs)

Class Summary

Have analgesic, anti-inflammatory, and antipyretic activities. Inhibit cyclooxygenase activity and prostaglandin synthesis.

Diclofenac ophthalmic (Voltaren)

A topical, ophthalmic NSAID. May facilitate outflow of aqueous humor and decrease vascular permeability. Any equivalent topical NSAID also can be used.

Indomethacin (Indocin, Tivorbex)

An oral formulation of NSAIDs. It is rapidly absorbed and metabolism occurs in the liver.

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Beta-adrenergic blockers

Class Summary

Reduce IOP by decreasing aqueous humor production via inhibiting synthesis of cyclic adenosine monophosphate in the ciliary epithelium. Prior to prescribing, consider effects on asthma and COPD.

Timolol maleate (Timoptic, Timoptic XE, Betimol, Istalol)

Criterion standard for ophthalmic beta-blockers. May reduce elevated and normal IOP, with or without glaucoma, by reducing production of aqueous humor or by outflow.

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Alpha-adrenergic agonists

Class Summary

Reduce IOP by reducing the formation of aqueous humor and increasing uveoscleral outflow.

Brimonidine (Alphagan P)

Selective alpha-2 receptor that reduces aqueous humor formation and increases uveoscleral outflow.

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Carbonic anhydrase inhibitors

Class Summary

Carbonic anhydrase is an enzyme found in many tissues of the body, including the eye. It catalyzes a reversible reaction where carbon dioxide becomes hydrated and carbonic acid dehydrated. By slowing the formation of bicarbonate ions with subsequent reduction in sodium and fluid transport, it may inhibit carbonic anhydrase in the ciliary processes of the eye. This effect decreases aqueous humor secretion thus reducing IOP.

Dorzolamide (Trusopt)

Topical formulation of carbonic anhydrase inhibitors.

Acetazolamide (Diamox Sequels)

Oral formulation of carbonic anhydrase inhibitor. Used for adjunctive treatment of chronic simple (open-angle) glaucoma and secondary glaucoma and preoperatively in acute angle-closure glaucoma when delay of surgery desired to lower IOP.

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Corticosteroids

Class Summary

Have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

Prednisolone acetate (Pred Forte, Omnipred, Pred Mild)

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability. Prior to use in PSS, consider the risk of steroid related increases in IOP.

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