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   Table of Contents      
CASE REPORT
Year : 1984  |  Volume : 32  |  Issue : 2  |  Page : 109-111

Hypersecretion glaucoma


Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

Correspondence Address:
B R Kalra
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
India
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Source of Support: None, Conflict of Interest: None


PMID: 6526461

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How to cite this article:
Kalra B R, Sood N N, Agarwal H C. Hypersecretion glaucoma. Indian J Ophthalmol 1984;32:109-11

How to cite this URL:
Kalra B R, Sood N N, Agarwal H C. Hypersecretion glaucoma. Indian J Ophthalmol [serial online] 1984 [cited 2021 Jan 21];32:109-11. Available from: https://www.ijo.in/text.asp?1984/32/2/109/27384

Hypersecretion glaucoma was described as a distinct clinical entity by Becker et al[1]. 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[2].

Hypersecretion glaucoma has been rarely reported[3].[4]


  Case report Top


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 Top


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[5],[6],[7]. Technical faults and a foot plate hole error[7] 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[6].

Our patient was a middle aged emotionally labile lady with a myopic refractive error. The association of myopia has earlier been poin­ted out.[3] The intermittent rise of intraocular pressure observed in this patient are charac­teristic of the condition.[4],[6] 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.[4],[6] It has been observed in 57% of cases of hypersecretion glaucoma without impaired outflow facility.[1]

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.[5] Thus periodic follow up with tonography should be done to detect the dec­reased facility of outflow.


  Summary Top


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 Top

1.
Becker, B., Keskey, G.R and Christensen, R.E. 1956, Arch. Ophthalmol. (Chicago), 56;180.  Back to cited text no. 1
    
2.
Becker, B., 1959, Symposium on glaucoma. Tran­sactions of the New Orleans Acad. Ophthalmol., p. 227. the C.V. Mosby Co., St. Louis.  Back to cited text no. 2
    
3.
Bock, J. and Stepanik, J., 1959, V. Graefes Arch. Ophthalmol., 160:654.  Back to cited text no. 3
    
4.
Metens, H., 1966, Klin. Mbl. Augenheilk., 148:175.  Back to cited text no. 4
    
5.
Drews, RC., 1971, Manual of tonography, p. 91. The C.V. Mosby Co., St. Louis.  Back to cited text no. 5
    
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.  Back to cited text no. 6
    
7.
Moses, R, 1959, Arch. Ophthalmol., 61:373.  Back to cited text no. 7
    


    Figures

  [Figure - 1], [Figure - 2]



 

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