1. Inflammatory
glaucoma

2. • Inflammatory glaucoma, also
known as uveitic glaucoma, is a
condition in which ocular
inflammation causes a
persistent or recurrent IOP
elevation resulting in
anatomical and physiological
changes

3. Diagnostic dilemmas:
1-IOP fluctuation :very sever in
inflammatory glaucoma
2-cillary body shut down:occuring
in acute exacerbation
3-steriod induced glaucoma
4-deficalty to assess fundus and
pirmetry
5-iris vessels confuse with NVG

4. • Pathogenesis
Intraocular pressure is regulated by a
balance between aqueous humor
production and its outflow. During
episodes of intraocular inflammation,
IOP is typically reduced because of
aqueous humor hyposecretion from
ciliary body inflammation and
increased uveoscleral outflow. Over
time, multiple mechanisms can
increase the resistance to aqueous
outflow during episodes of uveitis,
thereby leading to elevated IOP.

5. Classification:
1-open angle
2-closed angle
3-Posner-Schlossman syndrom

6. 1-open angle:
A- acute:either d.t.
-trabeculitis
-trabecular obestraction

8. B-chronic:
-d.t. trabecular scarring or
sclerosis 2ny to trabeculitis
-defecult to diagnose

9. 2-closed angle:
A- with seclusio pupillae
B-with PAS:mainly in
granulomatous inflamation

12. c/p:
1-open angle :
A-aute:
-IOP
-open angle
-sign of uveitis
-+/- keratitis

13. B-chorinic:
-IOP
-open angle
-no active inflammation
-sign of pervious episiod
-disc ,field changes

14. 2-closed angle:
A- with seclusio pupillae:
-IOP
-seclusio pupillae
-iris bombe
-shallow AC
-appositional angle closure
-sign of previous epesiod

15. B-with synechial closure:
-IOP
-shallow AC
- angle closure
-sign of previous epesiod

16. • D.D:
-Steriod induced
-pig.glaucoma
-neovascular
-PEX

17. TTT:
• Medical:
The following drug is CI:
1-miotics
2-PG analogue
3-biremonidine
4-metipranolol

18. • So, the 1st
line of ttt is B-blocker
Then we may use :
-CIA (systemic or topical)
-Alpha agonist

19. • TTT of uvitis :
• Steriod
• Cycloplegic
• Cyclosporin
• Cytotoxic drugs

20. Laser PI:
• Should be large &multiple
• Intensive topical steriod

21. Surgical ttt:
A-pre-op precutions:
1-control uveitis for 3 m
2-topical steriod
3-systemic steriod

22. Intra –op precautions:
1-aviod combined cat –trab.
Surgery
2- use MMC
3-tight scleral suture to aviod
hypotony
Post op.:
• Steriod tapered ccording to
inflammation

23. 2-GDD:
If trab with MMC failed
Has good result
valves with Small surface area
are preferred
2 step surgery to avoid hypotony

24. 3-cyclodestruction :
May cause:
-increase inf.
-sever hypotony

25. Posner-Schlossman:
• unilateral recurrent episodes of
mild cyclitis and heterochromia.
• Its pathogenesis still remains
unknown, with suggested
possible associations including
an immunogenetic factor
involving HLA-Bw54, viral
infections (HSV and CMV)

26. Symp.:
• Blurring of vision
• Haloes
• No pain
• No redness

27. Sign:
• The IOP is in the range of 40 – 70
mmHg during an acute attack
• Minimal flare
• Few cells
• Few KPs
• No PAS&PS
• No shallow AC
• Open angle

29. D.D:
• Prodromal stage of ACG-----other
eye shallow AC
• Disc form kiratitis------decrease
corneal sensation
Ttt:
• Steriod
Aquas subresent

30. Fuch's Heterochromic
Iridocyclitis
• Def.:chronic non-granulomatous
ant. Uveitis
• age: middle
• Sex: F
• Unilat.

31. Symp:
• Decrease VA
• Floaters
• heterochoromia

32. Sign:
• White eye
• Cornea:KPs
• Iris:
-atrophy
-irir nodule
-heterochoromia
-no PS
• Angle:neovasculrization
• Vit.:vitrites
• Fundus :
• systemic

35. Ttt:
• Posterior subtenon steriod
• vitrectomy

36. HSV ant. Uveitis:
• Granuloatous ant. Uveitis
• IOP
• Sectoral iris atrophy
• Spontanous hyphema
• Corneal sign
Ttt:
• Steriod
• Oral aciclovire

38. Juvenile idiopathic
arthritis:
• Inf.arthritis lasting at least for
6wks befor the age of 16
• Classification:
-pauciarticular
-polyarticular
-systemic onset

39. • Ant.
• Unilat
• Chronic
• Non-granulomatous
Symp.:
• Asymptomatic
• VA
• Floaters

40. Sign:
• White eye
• Band keratopathy
• KPs
• Flare &cells
• PS
• CAT
• Glaucoma
• Vitritis
Ttt:
• Screening
• Topical steriod

41. Thank you