Uveitis is a type of ocular inflammatory disorder (OID), or eye inflammation, that can occur for a variety of reasons and can affect one or both eyes.* Approximately 20% of people with uveitis will develop uveitic glaucoma. Fortunately, there are many methods of treating this multifaceted disorder. Learn more about uveitis and uveitic glaucoma including its causes, symptoms, and treatment options. 

What is uveitis? 

Uveitis is a term used to describe a group of inflammatory diseases. It can be short-term or long-term, and it’s caused by eye inflammation that affects the eyewall, known as the uvea. 

Some of the symptoms associated with uveitis include: 

• Eye pain
• Blurry vision
• Headache
• Photophobia
• Colored halos 

How does uveitis cause uveitic glaucoma?

Elevated intraocular pressure (IOP) may lead to either open-angle or angle-closure glaucoma in uveitis. 

Uveitic glaucoma can develop from one or more of these reasons: 

• Inflammatory debris from uveitis obstructs the trabecular meshwork of the eye, which leads to fluid outflow decreasing and IOP increasing.
• Long-term uveitis leads to scarring and may obstruct fluid outflow. 

How is uveitic glaucoma diagnosed? 

Like all glaucoma, an eye doctor will do multiple tests before diagnosing you with uveitic glaucoma. 

Tests that may be performed include:

• Measuring your IOP
• Visual field test
• Corneal thickness test
• “Angle” test (gonioscopy)
• Imaging tests to view the vessels of your optic nerve 

What medications are used to treat uveitic glaucoma?

Treatment for uveitic glaucoma consists of controlling inflammation from uveitis and elevated IOP.

Medications to treat inflammation include:

• Topical, periocular, intravitreal, or systemic corticosteroids or nonsteroidal anti-inflammatory agents
• Immunomodulatory therapy when corticosteroids exacerbate underlying glaucoma and/or nonsteroidal anti-inflammatory agents have proved ineffective

For elevated IOP, treatment includes:

• Topical beta blockers (beta-adrenergic antagonists), alpha agonists, or carbonic anhydrase inhibitors (CAIs)
• Prostaglandins may be used with caution for those with well-controlled uveitis, as this medication could worsen inflammation.
• Systemic hyperosmotic agents, such as glycerin or mannitol, are used to rapidly lower IOP in an acute setting with medical supervision.

What surgical or laser treatments are available?

For severe uveitic glaucoma, surgery or laser treatments may be warranted. 

Options for surgical or laser interventions include:

• Glaucoma filtration surgery is used when IOP is uncontrolled on maximally tolerated medication therapy.
• Glaucoma drainage devices have been specifically used more in uveitic glaucoma, either as the initial glaucoma surgery or if the glaucoma filtration surgery fails.
• Laser iridotomy is used when the pupil is being blocked, also known as pupillary block glaucoma.
• Transscleral laser cyclophotocoagulation is reserved as a last-resort option. If this laser therapy fails, it could lead to permanent hypotony, or very low IOP, which also could negatively impact the eye.

Additional information on uveitic glaucoma can be found on the Glaucoma Research Foundation and American Academy of Ophthalmology websites.

*Eliassi-Rad, B., Francis, A., & Giaconi, J. (2020, May 13). Uveitic Glaucoma – EyeWiki. American Academy of Ophthalmology. https://eyewiki.aao.org/Uveitic_Glaucoma

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