Monday, 15 April 2013

Posner-Schlossman Syndrome

Glaucomatocyclitic crisis is a condition with self-limited recurrent episodes of markedly elevated intraocular pressure (IOP) with mild idiopathic anterior chamber inflammation. It is most often classified as secondary inflammatory glaucoma.
In 1948, Posner and Schlossman first recognized glaucomatocyclitic crisis and described the features of this syndrome.[1] For this reason, the entity is often termed Posner-Schlossman syndrome (PSS).
Posner and Schlossman identified the following features[2] :
Recurrent episodes of mild cyclitis
Uniocular involvement
Duration of attack varying from a few hours to several weeks
Signs of a slight decrease in vision, elevated IOP with open angles, corneal edema with a few keratic precipitates, heterochromia with anisocoria, and a large pupil in the affected eye
Normal visual fields
Normal optic disc
Normal IOP and outflow facility, and all provocative tests normal between episodes
Since this original description, other cases attributed to glaucomatocyclitic crisis have been found to deviate from these criteria.[3] For instance, some patients with glaucomatocyclitic crisis have abnormal aqueous humor dynamics and may have an underlying primary open-angle glaucoma (POAG).[4]
Additional features that are now recognized are as follows:
Almost exclusively, this condition affects individuals aged 20-50 years.
Both eyes may be involved at different times but very rarely contemporaneously.[5, 6]
The rise of IOP is out of proportion to the severity of the uveitis, and this rise in IOP precedes the identifiable inflammatory reaction, often by several days.

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