Ophthalmology
Posner-Schlossman Syndrome
Posner-Schlossman syndrome (PSS), also known as glaucomatocyclitic crisis, is a rare cause of inflammatory ocular hypertension. Once thought to be benign, PSS is now known to be associated with significant ocular morbidity and loss of vision. The condition is characterized by recurrent episodes of uniocular rise in intraocular pressure (IOP) that are out of proportion with minimal intraocular inflammation. Cytomegalovirus infection of the anterior chamber may also be associated with this disease
v1 · Reviewed Nov 7, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
- To avoid irreversible functional and morphological visual loss, PSS must be promptly diagnosed and treated.
- During acute episodes, patients with PSS frequently report abrupt and intense eye pain, redness, blurred vision, and halos around lights.
- The condition is characterized by recurrent episodes of uniocular rise in intraocular pressure (IOP) that are out of proportion with minimal intraocular inflammation.
- Cytomegalovirus infection of the anterior chamber may also be associated with this disease, which can lead to visual field loss and glaucomatous optic neuropathy.
- A thorough eye examination, which is primarily clinical, is necessary for diagnosing PSS.
- Ophthalmologists will measure the patient's IOP, look for inflammation in the anterior chamber, and rule out other possible causes of glaucoma.
- Diagnostic procedures like gonioscopy and imaging may be carried out to assess the angle of the eye's drainage system and rule out other types of glaucoma.
- An essential investigation in characterizing PSS is PCR analysis of aqueous humor tap to assess viral DNA.
- It is essential to perform central visual field testing (Humphrey visual field, 24-2 or 30-2) to assess a glaucomatous pattern of visual field loss suggestive of optic nerve damage.
- Features suggesting a diagnosis of PSS include a history of recurrent acute attacks, high IOP with disproportionately few anterior chamber cells, and 1 or 2 sentinel keratic precipitates over the inferior endothelium.
- Management during an episode is aimed at controlling the IOP and minimizing intraocular inflammation.
- First-line treatment for reduction of IOP during acute attacks includes topical beta-blockers, alpha agonists, and carbonic anhydrase inhibitors, which are commonly used in the management of glaucoma.
- Intraocular inflammation, often mild, can be controlled using topical steroids such as prednisolone or dexamethasone.
- Topical and oral nonsteroidal anti-inflammatory drugs (NSAIDs) can suppress inflammation.
Cortisone
Topical
- Adult
- four times a day
- Renal
- Not specified in source
- Duration
- if needed, then quickly tapered
Valganciclovir
Oral
- Adult
- 900 mg twice daily for at least 2 weeks, followed by an additional 450 mg valganciclovir twice-daily maintenance therapy
- Renal
- Not specified in source
- Duration
- Not specified in source
Valganciclovir
Intravitreal
- Adult
- 2 mg/0.05 mL
- Renal
- Not specified in source
- Duration
- Not specified in source
- It is best to avoid topical prostaglandin analogs because of the risk of exacerbating inflammation.
- Topical pilocarpine should be discouraged as this is thought to exacerbate trabeculitis.
- If medical treatment is unsuccessful, surgery is used to lower IOP in patients with PSS.
- Trabeculectomy with MMC reduces IOP spikes and improves inflammation and PSS.
- Other IOP-lowering surgical techniques used in PSS include trabectome surgery, trabeculectomy, canaloplasty, and Ahmed glaucoma drainage device insertion.
- As in postuveitic corneal endothelial insufficiency, penetrating keratoplasty (PK) or Descemet's stripping automated endothelial keratoplasty (DSAEK) can be employed to treat a similar complication in PSS.
- Patient follow-ups should be conducted daily to monitor IOP during an acute episode and ensure the lowering of IOP to a safe level.
- Less frequent visits (weekly or monthly as appropriate) can be adopted when steroid and ocular hypotensive are tapered.
- Instructions to consult with an ophthalmologist as soon as an attack is noted should be given.
- The finding of progressive optic disc cupping and disc hemorrhage after an acute attack of severely elevated IOP may suggest permanent damage to the optic disc.
- Optical coherence tomography (OCT) and OCT angiography (OCTA) of the optic disc provide useful information about optic nerve structure, retinal nerve fiber layer, and peripapillary vessel density.
- In eyes with PSS associated with endothelins, the anterior segment OCT of the cornea depicts an irregular and highly reflective endothelial cell layer.
- Over an extended period and with the protracted rise in IOP, permanent glaucomatous damage may occur.
- Therefore, white cell count should be monitored in those patients on oral valganciclovir.
- reviewPosner-Schlossman Syndrome. StatPearls [Internet] — Ogugua N. Okonkwo, Marco Zeppieri, Koushik Tripathy — StatPearls Publishing, 2024
Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov