The Secondary Causes of Glaucoma

The Secondary Causes of Glaucoma

Q: I recently attended a lecture on viral eye disease in which the speaker differentiated between mucous plaques and dendriform lesions in herpes zoster that might harbor live virus. There are just two underlying explanations for this seemingly insurmountable hurdle: drug ineffectiveness or a flawed approval process. Her corrected visual acuity is 20/200. For example, we judge our management of allergic conjunctivitis to be a success when a patient responds to treatment with an absence of itching, redness and swelling. Please check your state licensing board to see if this approval counts toward your CE requirement for relicensure. Please check your state licensing board to see if this approval counts toward your CE requirement for relicensure. These days, better treatments are available and ODs have the license to use them.

This, unfortunately, is false. Ectropion, lagophthalmos, or thyroid ophthalmopathy increase the risk of progression. In uveitis, the structure of the chapter is different from those in other uveitis books. There was no history either of swimming with the contact lenses or of injury to the eye involving vegetation. This study determines intra- and inter- session repeatability of retinal vessel oxygen saturation, two weeks apart, on 18 participants using the Oxymap Retinal Oximeter. This was evidenced by characteristic transillumination defects in the iris.3 In 1992, researchers suggested that posterior bowing of the peripheral iris was caused by reverse pupillary block.4 This, in turn, led to the idea that a laser peripheral iridotomy (LPI) could remove the mechanical component of the disease by relieving the concavity. Slit lamp evaluation revealed diffuse conjunctival injection and a small circular epithelial defect with underlying stromal infiltration in the midperiphery of the right eye.

As the CD4 count declines and the viral load increases, the patient is at higher risk for opportunistic anterior segment infections. When drugs fail, laser trabeculoplasty becomes an option. Exam Findings The patient’s best-corrected visual acuity (BCVA) was 20/20 O.S. Another option, selective laser trabeculoplasty (SLT), applies less energy to the surgical site and induces less collateral damage.11 The diminished energy levels support the theoretical advantage of repeatable surgeries. Patients might undergo scheduled cleanings with SLT. Vesicular eruptions can occur externally, along the periorbital skin around the eyelids. • 2pm – 4pm.

Nevertheless, it’s something to consider as a possible cause of uveitis in a glaucoma patient. Patients with three or more recurrences should be referred for medical evaluation. What was most interesting to learn, however, is that pharmacists can now actually diagnose and prescribe for common eye conditions without the patient/customer ever having to see a doctor. More recently, XFS has been linked to an abnormal protein synthesis that creates a trabecular meshwork-blocking extracellular matrix synthesis.12 This obstruction can result in elevated IOP and conversion to exfoliation glaucoma (XFG). Because exfoliation syndrome can cause iridolenticular contact, liberated pigment may be deposited into the trabecular meshwork as well. You cannot realistically expect that both patients, who have markedly different presentations of dry eye disease, will respond similarly to one medication––even though there may be some overlap of clinical findings. Liu GS, Trope GE, Basu PK.

1. Corneal crystals that develop in middle age may be caused by either local dystrophy or systemic metabolic disease. Had the patient developed a secondary anterior uveitis, a cycloplegic agent would have decreased the inflammatory response and secondary pain triggered by the normal pupillary constriction to light; the same intervention is appropriate for patients with primary uveitis. Put a Plug in it Off-label indications apply not only to drugs, but also to devices such as punctal plugs, says Walt Whitley, OD, MBA, director of optometric services at Virginia Eye Consultants in Norfolk, Va. These specific colonies—generally referred to by their historic names methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus epidermidis (MRSE)—account for a large percentage of staphyloccal-associated eye infections. When tolerated, miotics have some advantages. For example, pilocarpine increases trabecular outflow and minimizes iridolenticular contact, thus reducing migration of pigment and exfoliative material to the trabecular meshwork.
The Secondary Causes of Glaucoma

Neither was the ulcer present nor were the symptoms of discharge, redness and pain from the first visit. The technique, which requires only a slit lamp, was applied to estimate the ACA of 50 participants (100 eyes) using two different models of slit lamp. Uveitic glaucoma (UG) presents a two-pronged and very serious problem: inflammatory damage to the trabecular meshwork and uvea coupled with steroid-induced ocular hypertension. It is perhaps the most difficult glaucoma to manage because we must simultaneously treat chronic inflammation and elevated IOP. According to studies, the incidence of secondary glaucoma in uveitis is between 10% and 20%.20,21 But, some of this data is based on diagnosing glaucoma solely as elevated IOP, not as visual field loss or optic nerve damage. One of the most common causes of secondary glaucoma in uveitis is idiopathic anterior uveitis. and O.S.

For example, herpes simplex keratouveitis progresses to glaucoma in 54% of cases, and herpes zoster uveitis progresses in 38%.22 Fuchs heterochromic cyclitis and sarcoid- related uveitis also yield high rates of glaucoma progression. Interactions with topical and oral nonsteroidal anti-inflammatory drugs (NSAIDs) may help explain unpredictable responses to glaucoma medications. When the forehead and scalp are affected (indicative of frontal nerve involvement), the upper eyelid may exhibit vesicles and edema. Speakers: Nicole Putnam, PhD, Kirk Smick, OD, Charles Kinnaird, OD, Anastas Pass, OD, JD, and Scot Morris, OD. 5. This ester-based agent has no propensity to raise IOP and is well suited for protracted tapering dosage. 2005 Jul 2-8;366(9479):37-43.

It develops secondary to ischemic processes in the retina and anterior segment. Early recognition of these processes increases the chance of preventing vision loss. Like dry eye, MFS is a chronic condition that causes patients to extract or “fish” strands of mucin from their eyes. Curr Eye Res 2004 Jun;28(6):437-44. Hom MM, Nguyen AL, Bielory L. Vascularization typically follows the initial inflammation and perpetuates it, before ultimately burning out and regressing. Slit lamp findings revealed deep scleral injection and thickening 360 degrees in the left eye without blanching upon instillation of  phenylephrine 2.5% (Figure 3).

Sheppard JD, Donnenfeld ED, Holland EJ, et al. Cysts are resistant to heat, ultraviolet radiation and lack of food, and may remain viable in this state for years. But, once the disease has transversed and reached the angle, the fibrovascular membrane obstruction in the meshwork will persist. Tube-shunt procedures hold promise as secondary options.29 Trans-scleral cyclophotocoagulation (TCP) and endocyclophotocoagulation (ECP) are also options for advanced or refractory cases. Vascular endothelial growth factor (VEGF) likely enables the neovascularization process, and current studies are investigating the uses of anti-VEGF drugs in the management of NVG. This report describes a congenital case of apparent inferior rectus palsy that was notable for suppression and retinal correspondence outcomes that varied with gaze direction. Aqueous-suppressing drugs include beta-blockers, alpha-agonists, and topical carbonic anhydrase inhibitors.

Oral carbonic anhydrase inhibitors are also useful for treating NVG. PGAs should be used cautiously; there is a risk of inflammation, they do not suppress aqueous production, and they will vary in results. The secondary glaucomas are a complex group of diseases that require careful diagnostic considerations. Dr. Recognition of the underlying causes of inflammatory and neovascular glaucoma can help in the triage efforts of multidisciplinary clinicians. Dr. Prednisolone acetate 1% QID to Q4H is recommended, with a slow taper over a few months.

Speakers will include: Lucia Sobrin, MD, MPH, who will lead a discussion about the impact of the growing field of molecular genetics on patient care and clinical outcomes; Matthew Petroll, PhD, who will present his work on the development and clinical implementation of ophthalmic imaging devices, with an emphasis on confocal microscopy, including data he acquired from the first confocal microscope ever used to image the human cornea; and Andrew Lee, MD, who will speak about the impact of clinical trials, focusing on the Optic Neuritis Treatment Trial’s influence on practice patterns. 1985 Feb;26(2):170-5. 23. Warwar RE, Bullock JD, Ballal D. Cystoid macular edema and anterior uveitis associated with latanoprost use. Experience and incidence in a retrospective review of 94 patients. Patients with dysphoria, fixation disparity, proprioceptive disparity and/or a vertical imbalance between the two eyes often will complain of dryness, grittiness, ocular irritation, visual fatigue, blurred vision and headaches.

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