Differential Diagnosis - Pacific University

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Diagnosis and Management of
Posner-Schlossman Syndrome
Jonee Brandt O.D.
VA Puget Sound Health Care System: American Lake
Division
jonee.brandt@gmail.com
What is Posner-Schlossman
Syndrome
• First described in 1948 by Abraham Schlossman and Adolf Posner
who had a series of 9 patients with similar symptoms and
characteristics of both glaucoma and uveitis.
• Uncommon inflammatory eye condition, classically unilateral, with
elevated intraocular pressures and minimal inflammation.
• Recurrent
• Tends to occur in young-middle aged adults, male>female, with no
racial predilection.
• Accounts for about 4% of all anterior uveititis.
Typical Presentation
*Acute intermittent history of mild blurred vision and minimal unilateral
discomfort
*Mild conjunctival injection, minimal anterior chamber reaction, small to
medium keratitic precipitates, NO posterior synechiae, possible iris
heterochromia/sectoral atrophy, and markedly elevated IOP.
*Acute attacks will resolve spontaneously in a matter of days-weeks
*Recurrence of attacks can vary greatly from patient to patient
Differential Diagnoses
• Herpes Simplex Trabeculitis
- Viral infection of endothelial cells of TM, cellular swelling and lysis 2’ to
immune attacks
- Management: IOP control, antivirals, and concurrent topical steroid tx
- May also present with: corneal endotheliitis and 2’ edema
- (+)HSV, possible h/o keratitis
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Differential Diagnoses
Fuch's Heterochromic Iridocyclitis
● Iris heterochromia
● Chronic mild unilateral anterior uveitis which does
NOT respond to steroid treatment
● Triad of heterochromia, cataract, and glaucoma
Differential Diagnoses
• Pigmentary Glaucoma
-Krukenberg’s spindle, iris TID’s,
pigment in TM
-glaucomatous changes to optic nerve
head
• Angle Closure/Angle
Closure Glaucoma
-closed angle on gonioscopy
-likely more severe symptoms:
including nausea/vomiting, facial
pain, haloes around lights
Coursebook Page 41 of 139
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