Which physical findings are characteristic of Posner-Schlossman syndrome (PSS) (glaucomatocyclitic crisis)?

Updated: May 18, 2020
  • Author: Leonard K Seibold, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Answer

On examination, the eye appears quiet with no injection. The pupil often is dilated slightly or sluggishly reactive. The anterior chamber is deep and has an open angle on gonioscopy, which should be performed in all cases to differentiate PSS from angle-closure glaucoma.

IOP usually is elevated in the range of 40-60 mm Hg. IOP is related to the duration of uveitis, not to the degree of uveitis. Eyes with active inflammatory disease often have wide swings in IOP that can lead to glaucomatous damage. The elevated IOP in PSS can last for several hours to a few weeks; therefore, it may be missed on initial examination. If the elevated IOP is of significant duration and elevation, corneal epithelial edema develops.

Signs of anterior inflammation are characteristically minimal with faint flare, rare cells, and only a few keratic precipitates (KPs). KPs are typically stellate, flat, nonpigmented, and concentrated over the inferior half of the endothelium. [13] Fine KPs appear after 2-3 days of elevated IOP and resolve rapidly. The inflammation never leads to the development of posterior synechiae or peripheral anterior synechiae. Fresh precipitates may appear with each episode of increased IOP.

Heterochromia, described in the original paper by Posner and Schlossman, is no longer considered a characteristic of this syndrome.

Typical of inflammatory conditions, early segmental iris ischemia and associated late iris-vessel congestion have been observed. These vessels leak on iris fluorescein angiography.


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