Uveitic Glaucoma

Updated: Sep 30, 2020
  • Author: Leon Herndon, Jr, MD; Chief Editor: Inci Irak Dersu, MD, MPH  more...
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In 1813, Joseph Beer first reported the association of uveitis and glaucoma, describing it as arthritic iritis followed by glaucoma and blindness. In 1891, Priesley Smith proposed the first modern classification of uveitic glaucoma. Later, specific types of uveitic glaucoma were described by Fuchs in 1906 (Fuchs heterochromic uveitis) and Posner and Schlossman in 1948 (glaucomatocyclitic crisis).



The mechanisms by which uveitis leads to elevated intraocular pressure (IOP) are numerous and poorly understood. In general, iridocyclitis affects both aqueous production and resistance to aqueous outflow, with the subsequent change in IOP representing a balance between these two factors. Inflammation of the ciliary body usually leads to reduced aqueous production, and combined with increased uveoscleral outflow often seen in inflammatory states, hypotony often is a consequence.

Prostaglandins, which have been demonstrated to be present in the aqueous of eyes with uveitis, are known to cause elevated IOP without a reduction in outflow facility. Mechanisms of increased resistance to aqueous outflow with both acute and subacute forms of uveitis usually are of the open-angle type and include obstruction of the trabecular meshwork by inflammatory cells or fibrin, swelling or dysfunction of the trabecular lamellae or endothelium, and inflammatory precipitates on the meshwork. Uveitis also may be associated with secondary angle-closure glaucoma.

Alteration of the protein content of the aqueous humor may be a cause of elevated IOP in uveitis. Increased levels of protein in the aqueous are a result of increased permeability of the blood-aqueous barrier, which leads to an aqueous that more closely resembles undiluted serum. This elevated protein content may, in fact, lead to aqueous hypersecretion and IOP elevation.

The treatment of the uveitis can lead to elevated IOP. Although corticosteroids have proven to be effective in relieving inflammation, prolonged administration can result in elevated IOP. Corticosteroids increase IOP by decreasing aqueous outflow. Several theories have been proposed to explain this phenomenon, including accumulation of glycosaminoglycans in the trabecular meshwork, inhibition of phagocytosis by trabecular endothelial cells, and inhibition of synthesis of certain prostaglandins.




United States

The prevalence of uveitis has been estimated at approximately 115 people per 100,000 in the United States. Approximately 20% of uveitis patients develop glaucoma.


The prevalence of uveitis has been estimated at 38-730 people per 100,000 worldwide. Approximately 20% of uveitis patients develop glaucoma.


Acute iridocyclitis usually produces symptoms; however, subacute iridocyclitis produces few or no symptoms but can have serious consequences because its complications may go undetected until advanced damage has occurred. If the inflammation is not controlled promptly, posterior synechiae and peripheral anterior synechiae (PAS) can form, leading to progressive angle closure and irreversible optic nerve damage.


No known racial predilection exists.


No known sexual predilection exists.


No known age predilection exists.



Few published reports are available that address the results of surgery in patients with uveitic glaucoma.

Hoskins et al achieved successful lowering of IOP in 6 of 9 eyes undergoing trabeculectomy for uveitic glaucoma. [1]

Hill et al showed a success rate of 81% at 12 months. The success rate of trabeculectomy with antimetabolite supplementation has been reported to be higher (71-100%). [2]

Wright et al reported that 3 of 24 patients undergoing trabeculectomy with mitomycin-C required subsequent drainage implants and that 7 of 24 patients lost 2 or more lines of Snellen acuity. [3]

Hill et al reported a success rate of 79% of eyes undergoing Molteno tube implantation. [4]

Ceballos et al reported a success rate of 91.7% in eyes undergoing Baerveldt drainage device placement for uveitic glaucoma. [5]

Ozdal et al showed a 2-year success rate of 60% in eyes undergoing Ahmed drainage device placement for uveitic glaucoma. [6]

Rachmiel et al reported similar 30-month results between eyes that underwent Ahmed glaucoma valve implantation with uveitic glaucoma compared to open-angle glaucoma eyes. [7]


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