Inflammatory glaucoma

• Inflammatory glaucoma, also known as uveitic glaucoma, is a condition in which ocular inflammation causes a persistent or recurrent IOP elevation resulting in anatomical and physiological changes

Diagnostic dilemmas:

1-IOP fluctuation :very sever in inflammatory glaucoma

2-cillary body shut down:occuring in acute exacerbation

3-steriod induced glaucoma4-deficalty to assess fundus and

pirmetry5-iris vessels confuse with NVG

• PathogenesisIntraocular pressure is regulated by a

balance between aqueous humor production and its outflow. During episodes of intraocular inflammation, IOP is typically reduced because of aqueous humor hyposecretion from ciliary body inflammation and increased uveoscleral outflow. Over time, multiple mechanisms can increase the resistance to aqueous outflow during episodes of uveitis, thereby leading to elevated IOP.

Classification:

1-open angle2-closed angle3-Posner-Schlossman syndrom

1 -open angle:

A- acute:either d.t.-trabeculitis-trabecular obestraction

B-chronic:-d.t. trabecular scarring or sclerosis

2ny to trabeculitis-defecult to diagnose

2-closed angle:A- with seclusio pupillaeB-with PAS:mainly in granulomatous

inflamation

c/p:

1-open angle :A-aute:-IOP-open angle-sign of uveitis-+/- keratitis

B-chorinic:-IOP-open angle -no active inflammation -sign of pervious episiod-disc ,field changes

2-closed angle:A- with seclusio pupillae:-IOP-seclusio pupillae-iris bombe-shallow AC-appositional angle closure -sign of previous epesiod

B-with synechial closure: -IOP-shallow AC- angle closure -sign of previous epesiod

• D.D:-Steriod induced -pig.glaucoma-neovascular -PEX

TTT:

• Medical:The following drug is CI:1-miotics2-PG analogue 3-biremonidine4-metipranolol

• So, the 1st line of ttt is B-blockerThen we may use :-CIA (systemic or topical)-Alpha agonist

• TTT of uvitis :• Steriod• Cycloplegic• Cyclosporin• Cytotoxic drugs

Laser PI:• Should be large &multiple• Intensive topical steriod

Surgical ttt:A-pre-op precutions:1-control uveitis for 3 m2-topical steriod 3-systemic steriod

Intra –op precautions:1-aviod combined cat –trab. Surgery2- use MMC 3-tight scleral suture to aviod

hypotony

Post op.:• Steriod tapered ccording to

inflammation

2-GDD:If trab with MMC failedHas good result valves with Small surface area are

preferred 2 step surgery to avoid hypotony

3-cyclodestruction :May cause:-increase inf.-sever hypotony

Posner-Schlossman:

• unilateral recurrent episodes of mild cyclitis and heterochromia.

• Its pathogenesis still remains unknown, with suggested possible associations including an immunogenetic factor involving HLA-Bw54, viral infections (HSV and CMV)

Symp.:• Blurring of vision• Haloes• No pain• No redness

Sign:• The IOP is in the range of 40 – 70

mmHg during an acute attack• Minimal flare• Few cells• Few KPs• No PAS&PS• No shallow AC• Open angle

D.D:• Prodromal stage of ACG-----other eye

shallow AC• Disc form kiratitis------decrease

corneal sensation Ttt:• SteriodAquas subresent

Fuch's Heterochromic Iridocyclitis

• Def.:chronic non-granulomatous ant. Uveitis

• age: middle • Sex: F• Unilat.

Symp:• Decrease VA • Floaters• heterochoromia

Sign:• White eye• Cornea:KPs• Iris:-atrophy-irir nodule-heterochoromia-no PS• Angle:neovasculrization• Vit.:vitrites• Fundus :• systemic

Ttt:• Posterior subtenon steriod• vitrectomy

HSV ant. Uveitis:

• Granuloatous ant. Uveitis• IOP• Sectoral iris atrophy • Spontanous hyphema• Corneal signTtt:• Steriod • Oral aciclovire

Juvenile idiopathic arthritis:

• Inf.arthritis lasting at least for 6wks befor the age of 16

• Classification:-pauciarticular-polyarticular-systemic onset

• Ant. • Unilat• Chronic• Non-granulomatous Symp.:• Asymptomatic• VA• Floaters

Sign:• White eye • Band keratopathy• KPs• Flare &cells• PS• CAT• Glaucoma• VitritisTtt:• Screening• Topical steriod

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