|Year : 1953 | Volume
| Issue : 4 | Page : 119-121
Glaucomatocyclitic crisis - Posner-Sclossman Syndrome
New Delhi, India
|Date of Web Publication||12-May-2008|
N S Jain
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jain N S. Glaucomatocyclitic crisis - Posner-Sclossman Syndrome. Indian J Ophthalmol 1953;1:119-21
The syndrome of glaucomatocyclitic crisis, although rare, is now a well known entity in ophthalmology since it was first described by Posner and Sclossman (1948), and subsequently reported by Billet (1952), Theodore ( 1952) and others. It is a recurrent glaucoma with very high tension in one eye, with minimal signs of uveal inflammation and quickly responsive to conservative treatment alone.
The diagnosis is controversial since on the one hand, disregarding the signs of mild iridocyclitis, the clinical picture simulates a short attack of acute primary glaucoma and on the other an extremely mild attack of iridocyclitis, with unexplained tension which is far in excess of the inflammation. This leads in either case to a mistaken diagnosis and hence an unnecessary prolongation of the malady and uncalled for surgery. The syndrome embraces features of both.
The accompanying table elucidates the points of differential diagnosis from an acute primary glaucoma and secondary glaucoma resulting from iridocyclitis.
| Case Report|| |
History - Chowdhry, T. R,, landlord. 65 years old, complained of severe lacrimation, discomfort, redness of right eye. Three days later a medical practitioner diagnosed it as acute primary glaucoma and started the treatment with 1% Eserine solution and continued it for one week. During this period the patient developed intense pain, marked congestion of the eye and excessive lacrimation.
Clinical Signs - First examined by me on the eleventh day since the onset of complaints. The following signs were noted -- adema of the eyelids of the right eye, intense circumcorneal injection, corneal edema, deep anterior chamber, contracted pupil, stature cataract, tension ± ± - ( which could not he recorded with tonometer owing to the tenderness of the globe).
Slit lamp examination ( rendered easier after instillation of pantocaine, adrenalin and glycerine ) revealed the presence of two tiny keratic precipitates on the hack of the cornea, a few inflammatory cells in the anterior chamber and aqueous flare.
Treatment- Ung. atropine sulph. ½% applied and continued for two days, and cortisone acetate ophthalmic suspension instilled and continued two hourly for six days.
Follow up - - The same day within two hours of commencing the treatment the pupil began dilating and revealed the presence of a very small posterior synechia at two o'clock position. Pain was less. The next day pain had completely subsided, lacrimation and congestion were less by 50% and the synechia had completely disappeared. The eye became quiet on the sixth day and the tension was reduced to 30 mm. Hg ( Schiotz ).
Two days later there was a recurrence of increased tension, with circumcorneal injection, discomfort and corneal (edema. Cortisone drops were again started but atropine was not instilled. Three days later the tension was well controlled and other symptoms were relieved to a great extent. The patient became completely asymptomatic again on the sixth day and remained so thereafter.
| Discussion|| |
This case has led to considerable controversy in various circles about the correctness of its diagnosis, but viewed in light of the arguments tabulated, the items marked with an asterisk point towards glaucomatocyc.litic crisis. The aetiology in this case remained obscure and uninvestigated in view of the necessity for an urgent treatment of an acute ailment which recovered remarkably quickly obviating the necessity for further investigations. This, the age, the unilaterality, the unduly high tension with minimal signs of uveal inflammation, the adverse symptoms and signs produced by a miotic, the rapid response to cortisone and complete absence of subsequent complications lend a strong support to the diagnosis.
That strong miotics are to be avoided in its treatment is clearly proved by the setting in of intense pain and congestion due to ciliary spasm developing from 1 % eserine in this case. This, in fact, very much altered the symptomatology and confused the diagnosis since intense pain and marked circumcorneal injection are not characteristic of this syndrome. Atropine had to be employed to relieve this and the patient recovered quickly with cortisone.
Recurrence, again being typical of the syndrome, was short lived and easily controlled.
| Summary|| |
A case of glaucomatocyclitic crisis is presented and its differential diagnosis discussed. The considerable possibility of mistaking the diagnosis with acute primary glaucoma, particularly after treatment with miotics, and an unnecessary operation are emphasised.
A table showing the points of difference between acute primary glaucoma, secondary glaucoma and glaucomatocyclitis crisis is presented.
| References|| |
Billet E. ( 1952) Amer. J. Ophth. 35, 214-216.
Posner A. and Sclossman A. ( 1948) Arch. Ophth. 39, 517-535.
( 1949) J. Amer. Med. Assn. 139, 82-85.
Theodore F. H. ( 1952), Brit. J. of Ophth. 36, 207-210.
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