|Year : 1984 | Volume
| Issue : 2 | Page : 109-111
BR Kalra, NN Sood, HC Agarwal
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
B R Kalra
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
|How to cite this article:|
Kalra B R, Sood N N, Agarwal H C. Hypersecretion glaucoma. Indian J Ophthalmol 1984;32:109-11
Hypersecretion glaucoma was described as a distinct clinical entity by Becker et al. The condition usually occurs in middle aged females with neurogenic hypertension and labile personality. It is characterised by intermittent or persistent rises of intraocular pressure in absence of disordered out-flow facility. It is believed to be caused by hypersecretion of aqueous humour due to disorder of a central regulating mechanism.
Hypersecretion glaucoma has been rarely reported.
| Case report|| |
T.R.H., a 48 years female was using 2% pilocarpine eye drops and oral acetazolamide (Diamox) for high intraocular pressure of `40' mmHg in both eyes.
There was no family history of glaucoma. She was a highly strung lady with blood pressure of 130/80 mm. Hg. The systemic examination was unremarkable. The laboratory tests were negative for diabetes.
Visual acuity of both eyes was 6/5 and J 1 with glasses. Examination of anterior segment did not reveal any abnormality. Gonioscopy showed wide open angles with normal pigmentation, A.C. depth was 2.5 mm. both eyes. On ophthalmoscopy shallow cups with dup-disc ratio of 0.6 and temporal myopic crescents were detected in both eyes. Applanation tonometry showed an I.O.P. RE 24 mm. and LE 32 mm. Hg.. Tonography revealed an outflow facility of 0.30 in the right eye and 0.25 in the left eye. Central fields showed faring of blind spot in the left eye while normal field of vision in the right eye.
The initial treatment with 1% pilocarpine eye drops four times a day and oral. Diamox controlled the intraocular pressure in the ranges of 14.0 to 20.0 mm. Hg. (applanation). Withdrawal of. Diamox lead to intermittent rises of I.O.P. to high twenties even 3 hours after pilocarpine.
She was reinvestigated after stopping all medications 48 hours prior to admission. Applanation tonometry showed an I.O.P. RE 26 mm. and LE 20 mm. Hg. The scleral rigidity was R/E 0.02 10 and L/E 0.0180. Diurnal variation by schiotz tonometry revealed 29.0 and 24.4 mm. Hg. as the highest and 12.2 and 10.2 mm. Hg. as the lowest intraocular tensions. The tonography performed on Berkeley electric tonometer depicted Po°27 mm. Hg. and `C'°0.39 in the right eye and Po° 19 mm. Hg. and `C'°0.35 in the left eye [Figure - 1][Figure - 2].
A trial with epitrate 1/2% eye drops twice daily dramatically reduced intraocular tension in both the eyes to below 20 mm. Hg. Later she developed allergy to epitrate and was shifted to Timolol 0.25% eye drops twice daily without altering the control of intraocular pressure.
| Discussion|| |
Hypersecretion glaucoma, needs to be distinguished because the conventional therapy (miotics) may not be effective in this condition.
Hypersecretion glaucoma is a diagnosis by exclusion of various conditions simulating tonographic tracing of this type of glaucoma,,. Technical faults and a foot plate hole error were excluded as the tonographic traing did not show a steep fall in the initial part 9. Early angle closure glaucoma and light scleral rigidity were ruled out by gonioscopy and applanation tonometry respectively. The possibility of a high scleral rigidity is further unlikely as the case showed poor response to miotic therapy and consistently similar tonographic findings were obtained.
Our patient was a middle aged emotionally labile lady with a myopic refractive error. The association of myopia has earlier been pointed out. The intermittent rise of intraocular pressure observed in this patient are characteristic of the condition., The fact that the patient had normal field in the right eye and an early field defect in the left eye conforms to the known belief that the field defects in hypersecretion glaucoma are minimal and slow in developing because of intermittent rise in tension., It has been observed in 57% of cases of hypersecretion glaucoma without impaired outflow facility.
The response to medical therapy in our patient was a very significant pointer to the diagnosis of hypersecretory glaucoma. The patient responding dramatically to the hyposecretory agents such as carbonic anhydrase inhibitors, topical epinephrine and timolol militate while the response to pilocarpine was capricious. The patients of hypersecretion glaucoma are known to usually convert to ordinary chronic simple glaucoma. Thus periodic follow up with tonography should be done to detect the decreased facility of outflow.
| Summary|| |
Hypersecretion glaucoma in a middle aged myopic female with a labile personality is being reported. Differential diagnosis of the conditions simulating hypersecretion glaucoma on the tonography is discussed. Conventional therapy of glaucoma with miotics may not be useful and hyposecretory agents are the treatment of choice in this condition.
| References|| |
|1.||Becker, B., Keskey, G.R and Christensen, R.E. 1956, Arch. Ophthalmol. (Chicago), 56;180. |
|2.||Becker, B., 1959, Symposium on glaucoma. Transactions of the New Orleans Acad. Ophthalmol., p. 227. the C.V. Mosby Co., St. Louis. |
|3.||Bock, J. and Stepanik, J., 1959, V. Graefes Arch. Ophthalmol., 160:654. |
|4.||Metens, H., 1966, Klin. Mbl. Augenheilk., 148:175. |
|5.||Drews, RC., 1971, Manual of tonography, p. 91. The C.V. Mosby Co., St. Louis. |
|6.||Kolker, A.E. and Hetherington J., 1976, BeckerShaffer's Diagnosis and therapy of the glaucoma, ed.4, p. 117. The C.V. Mosby Co., St. Louis. |
|7.||Moses, R, 1959, Arch. Ophthalmol., 61:373. |
[Figure - 1], [Figure - 2]