Sections

Posner-Schlossman Syndrome (PSS) (Glaucomatocyclitic Crisis)

Sections Posner-Schlossman Syndrome (PSS) (Glaucomatocyclitic Crisis)
Overview
Presentation
- History
- Physical
- Causes
- Complications
- Show All
DDx
Workup
Treatment
Medication
Questions & Answers
References

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.

Class Summary

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

Diclofenac ophthalmic (Voltaren)

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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)

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

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)

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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.

Class Summary

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

Brimonidine (Alphagan P)

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

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)

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Topical formulation of carbonic anhydrase inhibitors.

Acetazolamide (Diamox Sequels)

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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.

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)

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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.

Questions

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Su CC, Hu FR, Wang TH, Huang JY, Yeh PT, Lin CP. Clinical Outcomes in Cytomegalovirus-Positive Posner-Schlossman Syndrome Patients Treated With Topical Ganciclovir Therapy. Am J Ophthalmol. 2014 Aug 12. [QxMD MEDLINE Link].
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Jap A, Sivakumar M, Chee SP. Is Posner Schlossman syndrome benign?. Ophthalmology. 2001 May. 108(5):913-8. [QxMD MEDLINE Link].
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Author

Leonard K Seibold, MD Assistant Professor, Co-Director, Glaucoma Fellowship, Department of Ophthalmology, University of Colorado School of Medicine

Leonard K Seibold, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, Association for Research in Vision and Ophthalmology, Chandler Grant Glaucoma Society, Colorado Society of Eye Physicians and Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Erin G Sieck, MD Resident Physician, Department of Ophthalmology, University of Colorado School of Medicine

Erin G Sieck, MD is a member of the following medical societies: American Academy of Ophthalmology

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

Andrew I Rabinowitz, MD Director of Glaucoma Service, Barnet Dulaney Perkins Eye Center

Andrew I Rabinowitz, MD is a member of the following medical societies: Aerospace Medical Association, American Academy of Ophthalmology, American Society for Laser Medicine and Surgery, American Academy of Ophthalmology, American Medical Association

Disclosure: Nothing to disclose.

James H Oakman, Jr, MD Partner, Southern Eye Center, Augusta, Georgia

James H Oakman, Jr, MD is a member of the following medical societies: Association of American Physicians and Surgeons, Georgia Medical Society, Georgia Society of Ophthalmology, Georgia Society of the American College of Surgeons, American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Sections Posner-Schlossman Syndrome (PSS) (Glaucomatocyclitic Crisis)
Overview
Presentation
- History
- Physical
- Causes
- Complications
- Show All
DDx
Workup
Treatment
Medication
Questions & Answers
References

Posner-Schlossman Syndrome (PSS) (Glaucomatocyclitic Crisis) Medication

Medication Summary

Nonsteroidal anti-inflammatory drugs (NSAIDs)