How is Posner-Schlossman syndrome (PSS) (glaucomatocyclitic crisis) treated?

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

Complete medical care for patients presenting with glaucomatocyclitic crisis includes a reasonably thorough history of present illness, a review of drug allergies and sensitivities, a targeted past medical history and review of systems, a complete eye examination, a careful explanation of the disorder in accordance with the patient's level of understanding, and a commitment to long-term follow-up care of the patient. [39]

Medical therapy should be individualized to meet the patient's needs. The favored initial treatment is a combined regimen of a topical NSAID to control the anterior uveitis and an antiglaucoma drug for the elevated IOP.

Treatment recommendations include the following:

  • Topical NSAIDs - Diclofenac 0.1% 1 gtt TID/QID or equivalent plus
  • Topical antiglaucoma drops - Timolol 0.25-0.5% 1 gtt BID, brimonidine 0.2% 1 gtt BID/TID, or dorzolamide 2% 1 gtt BID/TID

The following can be considered:

  • Topical steroids - Prednisolone acetate 1% 1 gtt QID
  • Systemic carbonic anhydrase inhibitors - Acetazolamide 250 mg PO QID
  • Oral NSAIDs - Indomethacin 75-150 mg/d PO

Miotics and mydriatic agents are seldom used because they may have further deleterious effects on the blood-aqueous barrier and there is low risk for posterior synechiae formation. Long-acting periocular steroids are typically not recommended because of lingering IOP effects.

In the absence of underlying chronic glaucoma, antiglaucoma agents do not prevent recurrences of glaucomatocyclitic crisis; therefore, they are not necessary between episodes.

Topical and oral valganciclovir has recently been added as a treatment option in hopes of eliminating CMV in the anterior chamber, thus removing the infectious drive for uveitis. A 2010 retrospective study compared topical and oral valganciclovir and found that topical therapy had a higher failure rate; however, topical therapy yielded a lower recurrence rate. Multiple studies report that cessation of any form of antiviral therapy results in a high rate of recurrence, as valganciclovir is virostatic and not virucidal. [40] Long-term antiviral treatment is still being studied.


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