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Uveitis and Glaucoma - A Catch 22 Situation!

A 42 year old male patient walked into our OPD for an eye check-up complaining of gross diminution of vision in Left Eye since 3 months. He was using Prednisolone Acetate 1% q.i.d. for the last 2 months. On examination his best spectacle-corrected visual acuity in the Right Eye was 6/6 and Left eye Counting of Fingers at 3 m. Slit Lamp Examination of Right Eye was normal & Left Eye showed fine keratic precipitates adhered to the corneal endothelium. Anterior Chamber  was deep with 2+ cells. Pupil was sluggishly reacting. Intra Ocular Pressure was 14 and 40 mm Hg in the Right & Left eye respectively.

Gonioscopy showed open angle in all quadrants. The retina in Right Eye was normal and Left Eye showed 0.9:1 cupping with bipolar notching. Field test done in both eyes revealed advanced field loss in Left Eye. Hence the patient was diagnosed as Left Eye chronic uveitis with secondary glaucoma.

 Raised intraocular pressure in uveitis, either due to the disease itself or secondary to treatment with steroids, is one of the most common causes of secondary glaucoma in clinical practice. There are currently no standardized criteria for the diagnosis nor guidelines for the management of raised intraocular pressure in uveitis. Intraocular pressure elevation may be due to a combination of several mechanisms and, as a result, the prognosis differs from primary glaucoma. In addition, the management of on going inflammation without elevating the intraocular pressure remains a challenge.

                

              Keratic Precipitates                                                    Optic Disc Damage         Advanced Visual Field Loss

 

Take Home Message 

  • Intra Ocular Pressure (IOP)  should always be monitored for patients undergoing treatment for uveitis.

  • For patients with chronic uveitis, shift the patient to a milder steroid.

  • If any doubt of raised eye pressure, full investigation and glaucoma surgeon’s opinion is recommended.

About Advanced Eye Hospital and Institute:

Advanced Eye Hospital and Institute (AEHI) in Sanpada is one of the best eye hospitals in Navi Mumbai. Out of the 10 super eye specialists, it has one of the best glaucoma doctors in Navi Mumbai who are trained from prestigious Institutes of India. Eye injury, inflammation, steroids may cause high eye pressure leading to secondary glaucoma. While uveitis is treated with steroidal eye drops, hence creating a catch 22 situation for an eye doctor of glaucoma to treat both eye diseases. Nevertheless, patients of any degree of diminished vision or any eye problem should undergo detailed eye check-up as glaucoma is an irreversible eye disease.