Posner-Schlossman sydrome (glaucomatocyclitic crisis)

• repeated attacks of a mild cyclitis with significantly elevated IOP, usually unilateral
• asymptomatic or may have symptoms of sudden onset of blurred vision, mild pain and haloes around lights
• signs: mild anterior uveitis and high IOP (40-60), may have KPs w/ corneal edema, gonio open angle, mild degree of iris heterochromia and anisocoria (involved pupil larger)
• usually occurs b/w age of 20-50
• unknown etiology (possible allergy, viral infection such as CMV or herpes simplex, stress-induced)
• inflammatory material or precipitates on the TM reduce aqueous outflow or trabeculitis causes decreased outflow
• acute and self-limiting (resolves or without treatment), lasting hours to weeks
• associated with POAG and NAION in patients with small, crowded optic nerves
• treatment: control inflammation -- topical corticosteroid may be used alone or with IOP med (e.g. PF 1% qid qid with alphagan tid); don't use miotics or prostaglandins; no need for medication b/w episodes
• medical work-up: Chest x-ray, bilateral plain radiographs of ankles, feet and sacroiliac joints (to check for joint abnormalities), CBC with differential, ESR, TSH, HLA-B27, CRP, RF, ANA, Chorionic gonadotropin, RPR, Lupus