Managing Uveitic Glaucoma
JR Smith Casey Eye Institute, Oregon Health Sciences University, Oregon, USA

Glaucoma is a common and potentially blinding complication of uveitis. The pathogenic processes responsible for an underlying elevation in intraocular pressure are often multiple and may include both open angle and closed angle mechanisms. Successful management of uveitic glaucoma depends on recognition of the uveitis syndrome and clarification of the mechanism(s) contributing to the glaucoma. Both the inflammation and the raised intraocular pressure will require treatment. An anti-inflammatory regimen including corticosteroids, cytotoxic agents and/or specific immunosuppressive agents is chosen according to the type of uveitis, as well as various patient characteristics. When the angle is open, intraocular pressure reduction may be achieved medically using ß-adrenergic antagonists, 2-adrenergic agonists and/or carbonic anhydrase inhibitors. When medical treatment fails, surgical intervention, in the form of a trabeculectomy with wound modulation therapy or drainage implantation, is generally indicated. Laser iridotomy or surgical iridectomy may rapidly normalise intraocular pressure in patients with a closed angle.