Uveitic glaucoma

Uveitic Glaucoma is a form of glaucoma that is associated with uveitis, which is inflammation of the uvea or uveal tract of the eye. The uvea consists of the iris, ciliary body, and choroid. Uveitic glaucoma can develop as a complication of uveitis, leading to increased intraocular pressure (IOP) and potential damage to the optic nerve, resulting in vision loss.

Causes and Pathophysiology

Uveitic glaucoma is caused by the inflammatory process associated with uveitis, which can lead to alterations in the eye's aqueous humor dynamics. The mechanisms by which uveitis leads to glaucoma include:

• Trabecular meshwork dysfunction or obstruction, caused by inflammatory cells, proteins, or debris.
• Formation of posterior synechiae (adhesions between the iris and lens), leading to pupillary block and secondary angle-closure glaucoma.
• Neovascularization of the iris and angle, leading to neovascular glaucoma.
• Corticosteroid-induced glaucoma, as corticosteroids are a common treatment for uveitis but can increase IOP in susceptible individuals.

Symptoms

Symptoms of uveitic glaucoma may include:

• Blurred vision
• Eye pain
• Redness of the eye
• Sensitivity to light (photophobia)
• Decreased vision

It is important to note that symptoms of uveitic glaucoma can vary significantly among individuals, and some may not experience noticeable symptoms until the condition has progressed.

Diagnosis

Diagnosis of uveitic glaucoma involves a comprehensive eye examination, including:

• Measurement of intraocular pressure (IOP)
• Gonioscopy to examine the drainage angle of the eye
• Optical coherence tomography (OCT) to assess the optic nerve and retinal nerve fiber layer
• Visual field testing to evaluate the functional impact on vision

Treatment

Treatment of uveitic glaucoma aims to control inflammation, lower IOP, and prevent optic nerve damage. Treatment options may include:

• Anti-inflammatory medications, such as corticosteroids or immunosuppressive agents, to control uveitis.
• IOP-lowering medications, such as prostaglandin analogs, beta-blockers, alpha agonists, and carbonic anhydrase inhibitors.
• Laser therapy, such as laser trabeculoplasty or cyclophotocoagulation, to improve aqueous humor outflow or decrease aqueous humor production.
• Surgical interventions, such as trabeculectomy or glaucoma drainage device implantation, in cases where medical and laser therapies are insufficient.

Prognosis

The prognosis for individuals with uveitic glaucoma varies depending on the severity of the condition, the underlying cause of uveitis, and the response to treatment. Early detection and prompt treatment are crucial to prevent or minimize vision loss.

Prevention

Preventing uveitic glaucoma involves controlling inflammation in individuals with uveitis and monitoring for signs of increased IOP and glaucoma development. Regular eye examinations are essential for individuals at risk of or diagnosed with uveitis.