Posner-Schlossman Syndrome

Excerpt

In 1948, Posner and Schlossman published a series of 9 case reports of patients with the characteristic presentation of unique glaucoma, with open anterior angles of the anterior chamber, associated with unilateral acute elevations in intraocular pressure (IOP). This combination of symptoms later became known as Posner-Schlossman syndrome (PSS), a rare disease also called the glaucomatocyclitic crisis.

PSS is a unilateral ocular disease characterized by recurrent episodes of acute nongranulomatous anterior uveitis and increased intraocular pressure (IOP). This unique eye ailment manifests as a recurrent syndrome involving periodic rises in IOP. It differs from other glaucomas because it frequently involves mild-to-moderate anterior chamber inflammation; therefore, PSS is classified as inflammatory glaucoma.

These episodes of IOP can eventually result in secondary chronic glaucoma. Initial attacks may go undetected because of the mild nature of the uveitis. PSS can be misdiagnosed as an acute angle-closure glaucoma (ACG) episode early in the disease because of the acute marked elevation in IOP and unnoticed inflammatory reaction in the anterior chamber.

During acute episodes, patients with PSS frequently report abrupt and intense eye pain, redness, blurred vision, and halos around lights. Between bouts, some people may also experience slight discomfort or a gritty sensation in their eyes. The majority of the time, these symptoms affect only one eye at a time.

The exact prevalence of PSS is unclear. Although it can affect anyone of any age or gender, PSS mainly affects people between the ages of 20 and 50. It can be difficult to correctly quantify the syndrome's true incidence because of its sporadic nature.

A thorough eye examination, which is primarily clinical, is necessary for diagnosing PSS. Ophthalmologists will measure the patient's IOP, look for inflammation in the anterior chamber, and rule out other possible causes of glaucoma. Diagnostic procedures like gonioscopy and imaging may be carried out to assess the angle of the eye's drainage system and rule out other types of glaucoma.

The outlook for PSS over the long term is usually positive. If the illness is treated quickly, vision loss is uncommon, and increased IOP episodes typically go away on their own or without medical intervention. Repeated episodes of elevated IOP, however, have the potential to harm the optic nerve and cause permanent vision loss if they are not well managed. People with PSS must get continual monitoring and follow-up care to ensure their eye health is preserved.

The clinical course of the disease tends to exhibit a variable pattern. Patients can have frequent attacks with shorter symptom-free intervals or less frequent attacks with more prolonged symptom-free intervals; in between episodes, patients tend to have a normal IOP. In either case, the symptoms are self-limiting, with spontaneous resolution occurring within days or weeks, even without treatment.

Management during an episode is aimed at controlling the IOP and minimizing intraocular inflammation. The main objective of PSS therapy is to control the acute increase in IOP and inflammation that occurs during episodes. Topical and systemic drugs, like oral glaucoma medications and anti-inflammatory eye drops, are frequently used as part of treatment. IOP management may occasionally require more intrusive techniques, such as laser therapy or surgery.

Even though PSS is a well-known illness, further research is needed to grasp its underlying causes and risk factors fully. Prospects could involve the creation of more specialized treatments and enhanced diagnostic equipment to help with the early identification and treatment of PSS. Researching the genetic and immunological causes of the disease may also provide potential preventative measures.

This review aims to summarize information on the diagnosis and treatment of PSS.