Posner-Schlossman Syndrome (Glaucomatocyclitic Crisis) Treatment & Management

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

Medical Care

Complete medical care for patients presenting with glaucomatocyclitic crisis includes a reasonably thorough history of present illness, a review of drug allergies and sensitivities, a targeted past medical history and review of systems, a complete eye examination, a careful explanation of the disorder in accordance with the patient's level of understanding, and a commitment to long-term follow-up care of the patient. [39]

Medical therapy should be individualized to meet the patient's needs. The favored initial treatment is a combined regimen of a topical NSAID to control the anterior uveitis and an antiglaucoma drug for the elevated IOP.

Treatment recommendations include the following:

  • Topical NSAIDs - Diclofenac 0.1% 1 gtt TID/QID or equivalent plus
  • Topical antiglaucoma drops - Timolol 0.25-0.5% 1 gtt BID, brimonidine 0.2% 1 gtt BID/TID, or dorzolamide 2% 1 gtt BID/TID

The following can be considered:

  • Topical steroids - Prednisolone acetate 1% 1 gtt QID
  • Systemic carbonic anhydrase inhibitors - Acetazolamide 250 mg PO QID
  • Oral NSAIDs - Indomethacin 75-150 mg/d PO

Miotics and mydriatic agents are seldom used because they may have further deleterious effects on the blood-aqueous barrier and there is low risk for posterior synechiae formation. Long-acting periocular steroids are typically not recommended because of lingering IOP effects.

In the absence of underlying chronic glaucoma, antiglaucoma agents do not prevent recurrences of glaucomatocyclitic crisis; therefore, they are not necessary between episodes.

Topical and oral valganciclovir has recently been added as a treatment option in hopes of eliminating CMV in the anterior chamber, thus removing the infectious drive for uveitis. A 2010 retrospective study compared topical and oral valganciclovir and found that topical therapy had a higher failure rate; however, topical therapy yielded a lower recurrence rate. Multiple studies report that cessation of any form of antiviral therapy results in a high rate of recurrence, as valganciclovir is virostatic and not virucidal. [40] Long-term antiviral treatment is still being studied.

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Surgical Care

An occasional patient may require a filtering procedure, which is not effective in preventing recurrences of the episodes of iritis but may be useful in the management of high IOP seen with these episodes. [5, 41, 42]

Filtering surgery is generally not as effective in lowering IOP in uveitic glaucoma. During trabeculectomies in this population, higher levels of fibroblasts, lymphocytes, and macrophages are found in the conjunctiva, increasing the scarring of the bleb and decreasing the effectiveness of postoperative 5-FU subconjunctival injections. [43]

Laser trabeculoplasty likely provides no benefit in this population.

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Consultations

An ophthalmologist should be consulted to treat the elevated IOP and to provide long-term follow-up care for patients with POAG.

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Activity

No restrictions on activity are required.

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