Uveitic glaucoma is a secondary form of glaucoma caused by eye inflammation, known as uveitis. This combination of inflammation and elevated intraocular pressure (IOP) can damage the optic nerve, which transmits visual information from the eye to the brain. The condition is a recognized complication of uveitis, affecting an estimated 10-20% of individuals with eye inflammation. The development of glaucoma is more frequently associated with chronic forms of uveitis.
Managing uveitic glaucoma is a challenge because it requires addressing two interconnected problems. Treatment must control the underlying inflammation while also managing the high eye pressure threatening the optic nerve. This dual focus is necessary to protect against irreversible vision loss.
The Connection Between Uveitis and Glaucoma
The link between uveitis and glaucoma is established through mechanisms that increase pressure inside the eye. The most common pathway is an open-angle mechanism, where the eye’s drainage system becomes obstructed. During uveitis, inflammatory cells and debris clog the trabecular meshwork, the primary site of fluid outflow. This blockage prevents the eye’s internal fluid, aqueous humor, from draining properly, causing pressure to build.
Another way inflammation leads to high eye pressure is through an angle-closure mechanism. Chronic inflammation can cause scarring and adhesions (peripheral anterior synechiae) to form within the eye’s anterior chamber. These scars can pull the iris toward the trabecular meshwork, narrowing or closing the drainage angle. This prevents fluid from reaching the drainage system, leading to a rapid increase in eye pressure.
The treatment for uveitis itself is a further consideration. Corticosteroids are used to control inflammation but can also cause an increase in eye pressure in some individuals. This “steroid response” happens because corticosteroids can increase resistance to fluid outflow in the trabecular meshwork. This effect can develop weeks after starting steroid therapy and may complicate management.
Identifying Uveitic Glaucoma
The symptoms of uveitic glaucoma can be difficult to distinguish from the underlying uveitis. Patients may experience eye pain, sensitivity to light, blurred vision, and redness. When eye pressure rises quickly, individuals might see halos around lights or experience headaches and nausea. However, pressure often increases slowly, and patients may have no symptoms until significant vision loss has occurred.
To diagnose uveitic glaucoma, an ophthalmologist will perform several specific tests. A central component is tonometry, a procedure that measures the intraocular pressure (IOP). This measurement helps determine the severity of the pressure elevation and guides treatment decisions.
Another diagnostic tool is gonioscopy, which uses a special mirrored lens on the eye’s surface. This lens allows the doctor to visualize the eye’s drainage angle to determine if it is open, narrowed, or closed by scarring. This assessment is important for understanding the mechanism causing the high pressure.
An ophthalmologist will also examine the optic nerve for signs of damage using ophthalmoscopy. Glaucomatous damage often appears as a characteristic “cupping” of the optic nerve head. Visual field testing, or perimetry, is also performed to map a person’s peripheral vision and detect blind spots from optic nerve damage.
Treatment Strategies
The first priority in treatment is addressing the underlying uveitis. This is typically managed with corticosteroids, administered as eye drops, injections, or systemically as pills. For long-term control or in cases where steroids are not effective, other immunomodulatory drugs may be used to suppress the inflammatory response.
Simultaneously, medications are used to lower the elevated eye pressure and protect the optic nerve. The first-line choices are aqueous suppressants, which reduce the amount of fluid the eye produces. These include beta-blockers, alpha-adrenergic agonists, and carbonic anhydrase inhibitors. Prostaglandin analogs are sometimes avoided because they can worsen inflammation.
If medications fail to control eye pressure, surgery may be required. It is reserved for unresponsive cases because operating on an inflamed eye carries a higher risk of complications. Common surgical procedures include trabeculectomy, which creates a new drainage channel, or the implantation of a glaucoma drainage device, a small tube that redirects fluid out of the eye.
Long-Term Management and Outlook
Uveitic glaucoma is a chronic condition that necessitates a lifelong commitment to monitoring and treatment. Consistent follow-up with an ophthalmologist, often one who specializes in either uveitis or glaucoma, is required to manage the disease effectively. The primary goal of long-term care is to prevent further attacks of uveitis while keeping intraocular pressure at a level that does not cause additional damage to the optic nerve.
The prognosis for individuals with uveitic glaucoma can vary significantly and depends on factors like the severity and type of the underlying uveitis, how well the inflammation is controlled, and the patient’s response to treatment. While it is a serious condition that can lead to irreversible vision loss, many people are able to maintain good, functional vision for their lifetime with diligent care.
Successful management relies heavily on patient adherence to the prescribed treatment regimen and attending all scheduled follow-up appointments. Regular examinations allow the ophthalmologist to detect subtle changes in eye pressure or optic nerve health and adjust the treatment plan accordingly. This proactive approach is the most effective way to protect vision and prevent the progressive damage associated with the disease.