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Understanding Uveitic Glaucoma

What is Uveitis?

Ocular inflammatory disorders (uveitis) can occur for a variety of reasons, and unfortunately, glaucoma can afflict up to 20% of these patients. Some of these disorders tend to affect only one eye such as Fuch’s Heterochromic Uveitis, Posner-Schlossman Syndrome, and Herpetic uveitis. Other forms can affect both eyes, such as Juvenile Idiopathic Arthritis, ankylosing spondylitis, and sarcoidosis.

The treatment of uveitis depends on its cause. It is usually treated with corticosteroids, a class of drugs with anti-inflammatory action. Steroid medications for uveitis are most commonly administered as eyedrops, but may also be injected into or around the eye, or given as pills. Uveitis may also be treated with medications that modulate the immune system, and with antibiotics or anti-viral drugs for cases caused by certain infections.

How Does Uveitis Cause Glaucoma?

The relationship between uveitis and glaucoma is a complex one. We know that glaucoma is an optic neuropathy with elevated intraocular pressure (IOP) as one of its primary risk factors. Uveitis can cause increased IOP when inflammatory debris obstructs the trabecular meshwork resulting in decreased fluid outflow from the eye. In the long-term, inflammation can also cause scar tissue that further obstructs fluid outflow. In addition, corticosteroid treatment can, by itself, cause elevated IOP as a side effect.

How Can We Treat Uveitic Glaucoma?

Fortunately we have many methods of treating this multifaceted disorder; a treatment plan often includes a team of doctors working together. Sometimes, a rheumatologist will prescribe medication taken by mouth or even intravenously to focus on the root cause of inflammation. To treat elevated eye pressure, the glaucoma specialist will use many of the same IOP lowering drugs as for the other types of glaucoma. Laser treatments are typically not used as they can cause more inflammation. In cases that cannot be controlled medically, surgical treatment for inflammatory glaucoma usually involves placing a glaucoma drainage device.

The Takeaway

Patients with uveitic glaucoma may find their condition difficult to cope with. Thankfully, with modern treatments, many patients are able to maintain excellent vision.
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Article by Sarah Wellik, MD. Dr. Wellik completed her undergraduate and medical degrees at the University of California, Irvine, her ophthalmology residency at Boston University, and a glaucoma fellowship at Bascom Palmer Eye Institute at the University of Miami. She is currently an Associate Professor of Ophthalmology at Bascom Palmer Eye Institute in Miami, Florida.

Last reviewed on October 29, 2017

This article appeared in the September 2015 issue of Gleams.

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