Unilateral Glaucoma Clinical Presentation

Updated: Sep 05, 2017
  • Author: Ingrid U Scott, MD, MPH; Chief Editor: Hampton Roy, Sr, MD  more...
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Presentation

History

Elicit history of trauma, thyroid disease, congestive heart failure, vasculitis, malignancy, and other systemic diseases.

Diplopia may be a presenting complaint of patients with a carotid-cavernous sinus fistula, thyroid ophthalmopathy, or retrobulbar tumor.

Carotid-cavernous sinus fistulae often present after the following:

  • A severe head injury

  • Any penetrating injury to the orbit injuring the medial or inferomedial wall of the orbit and/or the superior orbital fissure

  • Surgery involving the internal carotid artery

  • Rupture of a preexisting aneurysm of the internal carotid artery

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Physical

Ophthalmic examination

Increased EVP may cause pulsating exophthalmos, conjunctival chemosis, engorgement of the episcleral vein, restricted ocular motility, ocular bruit, and ocular ischemia.

Dilated episcleral vessels are a prominent feature of Sturge-Weber syndrome; choroidal hemangioma is present in 31-50% of patients with Sturge-Weber syndrome.

A common clinical sign of an orbital varix is intermittent exophthalmos (exophthalmos occurring when the head is placed in a dependent position, when the patient sneezes, or when the patient performs a Valsalva maneuver).

Orbital tumors may cause proptosis and restricted ocular motility.

Thyroid ophthalmopathy may cause proptosis, restricted ocular motility, conjunctival chemosis, epiphora, exposure keratitis, and optic nerve compression.

Presenting signs of the superior vena cava syndrome include edema of the lid, face, and conjunctiva; vascular engorgement of the fundus, episclera, and conjunctiva; proptosis; optic nerve edema; and glaucoma.

IOP may increase while supine and may decrease while sitting.

The most common presenting manifestations of ICE syndrome are iris abnormalities (eg, iris atrophy, corectopia, ectropion uveae, peripheral anterior synechiae, iris nevi), decreased vision, and pain. Other features of the syndrome may include fine-hammered silver appearance of the posterior cornea and corneal edema.

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Causes

Glaucoma associated with EVP is due to increased resistance of aqueous outflow from the Schlemm canal and is associated with arteriovenous anomalies, venous obstruction, and idiopathic anomalies.

Glaucoma associated with ICE syndrome is believed to be due to trabecular meshwork obstruction caused by peripheral anterior synechiae or, less commonly, an abnormal cellular membrane.

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