|Title||A CASE OF RECALCITRANT POSNER-SCHLOSSMAN SYNDROME|
|Author, Co-Author||Stephanie Holt, G. Richard Bennett|
|Abstract|| BACKGROUND: Posner-Schlossman Syndrome is an ocular condition characterized by a recurrent, unilateral,acute elevation in intraocular pressure with mild cyclitis and an open angle. It typically affects individuals 20-50 years old and can last hours to a few weeks. This report presents an unusual case of an intractable, unilateral Posner-Schlossman Syndrome presumed to be a steroid-responder and discusses treatment considerations for future recurrences.
CASE REPORT(S): A 47-year-old black woman presented with a chief complaint of a red right eye with intermittent cloudy vision, photophobia, and haloes for 3 days. Her uncorrected visual acuities were 20/50 right eye and 20/40 left eye. Slitlamp examination revealed mild conjunctival injection and grade 1 flare in the right eye and corneal guttata in both eyes. Intraocular pressures were 34 mmHg right eye and 23 mmHg left eye by Goldmann applanation. Gonioscopy revealed open angles with no abnormalities. Treatment was initiated and at follow-up visits over the next three months, intraocular pressures fluctuated between 15 and 63 mmHg despite maximum medical therapy which included prednisolone acetate 1%. Increase in intraocular pressure appeared to coincide with an increase in steroid dosage prescribed during periods of increased inflammation. Intraocular pressure decreased to 19 mmHg after replacing prednisolone acetate with loteprednol and discontinuing it after a one week taper while continuing dorzolamide 2.0%, timolol 0.5%, and apraclonidine 0.5% each three times daily.
CONCLUSIONS: Recommended treatment for Posner-Schlossman Syndrome includes topical steroids, topical antiglaucoma drops, systemic carbonic anhydrase inhibitors, and topical or systemic non-steroidal anti-inflammatory agents. In cases where patients are suspected of being steroid-responders treatment other than topical steroids must be considered for control of ocular inflammation. Topical or oral non-steroidal anti-inflammatory agents such as diclofenac or indomethacin, respectively, have analgesic and anti-inflammatory properties and can be considered in these challenging cases.
|Affiliation of Co-Authors||Pennsylvania College of Optometry at Salus University|