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Secondary Open-Angle Glaucomas
Published in Neil T. Choplin, Carlo E. Traverso, Atlas of Glaucoma, 2014
Jonathan Myers, L. Jay Katz, Anand Mantravadi
Approximately one-third of patients with pigment dispersion syndrome will go on, over a period of years, to develop pigmentary glaucoma. Treatment of pigmentary glaucoma includes the full spectrum of pharmacological, laser, and surgical modalities. Miotics work well to lower pressures both by opening the trabecular meshwork and by pulling the iris away from zonular fibers, reducing pigment release. However, many of these young patients are intolerant of miosis-induced headaches and blurred vision. Longer-release preparations, such as pilogel and ocuserts, reduce these symptoms adequately for some patients. These patients are also at increased risk for retinal detachment with miotics. For these reasons, many clinicians start with aqueous suppressants, such as beta-blockers, alpha-agonists, and carbonic anhydrase inhibitors. Prostaglandin analogs can also be effective.
Bilateral Acute Depigmentation of Iris (BADI) Post COVID Infection following Systemic Moxifloxacin Therapy
Published in Ocular Immunology and Inflammation, 2023
Gazal Patnaik, Wadke Vidya Arunkumar, Mihir Lagvankar
Although BADI is a benign, self-limiting disorder, it needs to be differentiated with other potential severe clinical entities. Herpetic iridocyclitis is commonly associated with keratic precipitates and sectoral or diffuse iris atrophy. Pigment dispersion syndrome (PDS) is more commonly seen in young myopic males with a concave iris configuration. ASOCT and gonioscopy in our patient has ruled out any iris transillumination and iris concavity. SARS – CoV2 has been associated with various ocular manifestations.5 A temporal association with an interval of 2–3 months post acute infection has also been strongly reported, as seen in our case as well.6 To the best of our knowledge, BADI has never been associated with the novel virus yet. BAIT has been reported with the COVID infection, however, there was no association with the fluoroquinolones in that case.7 Various differentials need to be excluded so as to avoid unnecessary long term medical management with topical corticosteroids or toxic systemic antiviral medications or anti-glaucoma medications.8 Treatment with topical corticosteroids could also increase the risk of raised IOP, which may lead to secondary open angle glaucoma.
Keratic Precipitates: The Underutilized Diagnostic Clue
Published in Ocular Immunology and Inflammation, 2021
Nicole Shu-Wen Chan, Soon-Phaik Chee
Other ocular syndromes that involve pigments or deposits on the endothelium may mimic pigmented KPs in uveitis. Pigments embedded in guttata in Fuch’s endothelial corneal dystrophy or deposited on the endothelium in pigment dispersion syndrome may also be mistaken for pigmented KPs. One important clue is that pigments on the endothelium are smaller than KPs and do not have a dendritic appearance. Similarly, whitish fibrillogranular material that deposits on the endothelium in pseudoexfoliation syndrome may be mistaken for KPs.49 Eyes with pigment dispersion syndrome and pseudoexfoliation syndrome may be associated with elevated intraocular pressure. Failure to detect the associated signs of these conditions may lead the clinician to misdiagnose these patients with hypertensive viral anterior uveitis.
Differential Diagnosis of Viral-Induced Anterior Uveitis
Published in Ocular Immunology and Inflammation, 2018
Lia Judice Relvas, Laure Caspers, Soon-Phaik Chee, Manfred Zierhut, François Willermain
Sectoral iris atrophy of VZV and HSV typically involve the pigment epithelium, leading to iris transillumination, whereas the iris atrophy in FUS is diffuse and tends to be anterior stromal and consequently can induce heterochromia. Pigment dispersion syndrome and bilateral acute iris transillumination can also present with such a picture and should be thus included in the differential diagnosis. CMV AU may be associated with a more patchy stromal iris atrophy, retaining a round pupil but may also frequently present without any iris lesions (Figure 3). Fuchs uveitis may present with a diffuse atrophy that may lead to diffuse fine iris transillumination in some cases. Focal iris stromal hemorrhage may be seen in HSV/VZV uveitis and severe HSV or VZV AU may even present with hyphema, albeit rarely, and needs to be differentiated from spontaneous hyphema which may be occasionally seen in FUS often associated to RV.