Elevated intraocular pressure (IOP) in uveitic eyes may be acute, chronic, or recurrent. In eyes with long-term ciliary body inflammation, the IOP may fluctuate between abnormally high and low values. Numerous morphologic, cellular, and biochemical alterations occur in the uveitic eye that cause uveitic glaucoma and ocular hypertension. Successful management of uveitic glaucoma and ocular hypertension requires the identification and treatment of each of these contributing factors.
Assessment of patients with uveitis and elevated IOP should include the same measures taken as for any case of ocular hypertension: slit-lamp and dilated fundus examination, gonioscopy, evaluation of the optic nerve head with disc photographs and optical coherence tomography (OCT), and serial automated visual fields.
Moorthy RS, Mermoud A, Baerveldt G, Minckler DS, Lee PP, Rao NA. Glaucoma associated with uveitis. Surv Ophthalmol. 1997;41(5):361–394.
Uveitic Ocular Hypertension
Unilateral uveitis of sudden onset with open angles and increased IOP may be of infectious origin, particularly from viral causes but also from Toxoplasma. Thus, in the presence of active inflammation early in the course of uveitis, clinicians should resist the urge to prematurely taper corticosteroids because of a fear of corticosteroid-induced ocular hypertension. Corticosteroid-induced ocular hypertension rarely occurs before 3 weeks after the initiation of corticosteroid therapy. Early IOP elevations with active inflammation are almost always caused by inflammation that requires aggressive anti-inflammatory treatment.
Excerpted from BCSC 2020-2021 series: Section 9 - Uveitis and Ocular Inflammation. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.