Topic outline

  • Grand Rounds

    A patient presented with decreased vision in the left eye after being struck in the eye by a cabinet. The patient stated that he was struck in the eye 1 month prior to presentation, but only experienced decreased vision start 1 week prior. Upon presentation, visual acuity was 20/50 in the right eye and 20/70 in the left eye. IOP was 14mmHg in the right eye and 44mmHg in the left eye, which improved to 34 after 3 rounds of IOP-lowering drops. Gonioscopy revealed angles open to ciliary body band 360 in both eyes without peripheral anterior synechiae. Slit lamp examination disclosed only microcystic corneal edema and nuclear sclerotic cataract in the left eye. The patient’s condition was favored to represent worsening of his chronic angle recession glaucoma. The patient was started on maximum medical IOP drops and oral acetazolamide in the left eye and given a 1 day follow up appointment. Upon evaluation in clinic, the patient was found have anterior uveitis of the left eye, started on topical steroids and was given close follow up as his IOP had improved to 13mmg in the left eye. Upon further review of the patient’s records, it became clear that he did not have evidence of glaucomatous optic neuropathy on structural imaging, and no evidence of angle recession on gonio. He was having intermittent, acute severely elevated IOP only in the left eye, associated with mild unilateral anterior uveitis, mild corneal edema, minimal pain, and no angle abnormalities with normal IOP between episodes for months sometimes years. AC tap was performed at a subsequent visit and was negative for VZV, CMV, and EBV with insufficient sample for HSV. Iris angiogram demonstrated sectoral ischemia and leakage, the overall picture being most consistent with Posner-Schlossman Syndrome/ Glaucomatocyclitic Crisis.

    Presentation Date: 08/10/2023
    Issue Date: 08/25/2023