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Optic Disc Drusen Routine eye exam of a 58-year-old African-American female revealed small discs with visible optic disc drusen, for which she had been monitored with visual fields. Her best-corrected visual acuity was 20/20 and intraocular pressure was 19 in both eyes. Visual fields were concernin…

Normal Tension Glaucoma A 22-year-old previously healthy female from Guatemala presents as a referral for “severe glaucoma” with symptoms of intermittent headaches and gradual decline in vision most notable in the left eye. On exam the patient is found to have low-normal intraocular tension, op…

Aqueous Misdirection After Glaucoma Drainage Implant A 54-year-old male presented to the clinic flat anterior chamber 6 weeks after a glaucoma implant device. His vision was 20/200 in the affected eye with an IOP of 10. He had lenticular-corneal touch. His other eye was NLP from presumed POAG. He w…

Peters Anomaly Type II A 2-day-old male was referred by a neonatologist for evaluation and management of corneal clouding and buphthalmos of the left eye. The patient was found to have unilateral elevated intraocular pressure, corneal clouding, enlarged corneal diameter, and a poor red reflex. B-sc…

Radius-Maumenee Syndrome A 15-year-old male presented with elevated intraocular pressure of the left eye. Gonioscopy revealed blood in Schlemm’s canal. Fundoscopic examination and subsequent ophthalmic imaging confirmed a diagnosis of glaucoma in the left eye. Neuro-imaging was normal without sig…

Elevated Episcleral Venous Pressure A 59-year-old male presented with blurred vision in both eyes. He was referred to the glaucoma service for evaluation of elevated intraocular pressure. On examination, the patient was observed to have blood in Schlemm’s canal and bilateral intraretinal and subr…

Hypotony Maculopathy Following Trabeculectomy A 64-year-old man with juvenile open angle glaucoma in both eyes s/p trabeculectomy in both eyes with revision in the right eye presents with decreased vision. The patient was found to have visual acuity in right eye of 20/80, intraocular pressure of 5,…

Total Hyphema A 79-year-old female with no history of trauma presents to the Bascom Palmer Emergency room with one day of sudden decreased vision and pain in the right eye. One day prior, the patient underwent argon laser trabeculoplasty in the right eye for treatment of mild primary open angle gla…

Intraoperative Aqueous Misdirection A 3-year-old boy with primary congenital glaucoma OU s/p BVT (x1 OD, x2 OS) presents to clinic with elevated IOP OD despite maximum medical therapy. He undergoes exam under anesthesia with median intraocular pressure (IOP) 37 mm Hg OD. The patient then underwent …

This patient was referred for possible iris malignancy. Ultrasound confirmed no mass. There is atrophy of the iris nasally with some variable pigmentation.

Increased cup to disc ratio at > 0.9 with some peripapillary atrophy.

In this module, we will look at:




Glaucoma Pathology


Glaucoma Treatment

These are caused by failure of the embryonic fissure to close during the second month of development in utero. The iris defect is also known as a "keyhole" pupil. Here, there is not only an iris defect, but also missing tissue in the lens (yellow arrow) and zonules. This can cause difficulties duri…

Glaucoma Associated with Sturge Weber A 4-week-old male was brought in by his mother for evaluation of elevated pressures in the left eye. Exam was revealing for a port wine birth mark in the V1 and V2 distribution on the left. Patient demonstrated an IOP of 32 in the left eye, with marked corneal …

Steroid-Induced Glaucoma A 32-year-old female presented to Bascom Palmer Eye Institute complaining of an inferior field defect in her left eye. Examination revealed 20/20 vision with correction, an APD, normal IOP, PCIOL, and optic nerve pallor and cupping of the left eye. Right eye exam was WNL. H…

Posner-Schlossman Syndrome Due to CMV Virus A 31-year-old woman with recurrent intraocular pressure spikes despite acyclovir therapy was found to have PCR-confirmed CMV anterior uveitis consistent with one of the presumptive etiologies of Posner-Schlossman. She was started on oral valganciclovir an…