Which disorders should be included in the differential diagnoses of primary open-angle glaucoma (POAG)?

Updated: Mar 16, 2020
  • Author: Kristin Schmid Biggerstaff, MD; Chief Editor: Inci Irak Dersu, MD, MPH  more...
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Answer

Glaucoma is not just a disease of IOP but rather a multifactorial optic neuropathy. However, patients with OHT who have IOP outside of the statistically normal range should continue to have periodic follow-up examinations, because they are always at risk for development of glaucoma. Consider the following:

  • Other causes for optic neuropathy should be considered in all patients with apparent normal-tension glaucoma, and appropriate lab or radiologic testing should be initiated if history and/or physical findings are suggestive.

  • Patients who do not have elevated IOP but glaucomatous optic discs or visual fields may have normal-tension glaucoma. It is a diagnosis of exclusion (after other causes for optic neuropathy, such as temporal arteritis, have been investigated and ruled out).

Several secondary causes of glaucoma must be considered before diagnosing POAG. These causes include the following (see also Differentials):

  • Exfoliation syndrome

  • Pigment dispersion syndrome (pigmentary glaucoma)

  • Lens-induced glaucoma

  • Ocular inflammatory diseases

  • Intraocular tumors

  • Raised episcleral venous pressure

  • Topical or systemic corticosteroid use

  • Syndromes (eg, Axenfeld-Rieger syndrome)

Patients with glaucoma should be asked about cognitive status, since an association between Alzheimer disease and glaucoma has been found. [5]


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