Posner-Schlossman Syndrome and Nonarteritic Anterior Ischemic Optic Neuropathy

Abstract

A 41-year-old woman with acute OD pain and decreased visual acuity presented with anterior uveitis, an intraocular pressure of 56 mm Hg, an open angle, ipsilateral nerve fiber bundle visual field defects, and optic nerve edema. With control of intraocular pressure and uveitis, visual acuity improved to 20/25, visual field defects persisted, and optic disc pallor developed. She has remained stable over 23 months of follow-up. This case represents a concurrence of glaucomatocyclitic crisis (Posner-Schlossman syndrome, PSS) and nonarteritic ischemic optic neuropathy (NAION). Although this combination occurs rarely, patients with PSS and other risk factors for NAION, including an optic disc that lacks a physiologic cup, should be protected against NAION by prophylactic treatment with ocular antihypertensive medications.

Bilateral nonarteritic anterior ischemic neuropathy following acute angle-closure glaucoma in a patient with iridoschisis: case report

“…Automated perimetry in previously reported cases revealed: a superior altitudinal visual field defect, dense superior and inferior arcuate defects and an inferior altitudinal defect (9)(10)(11) . Most of these clinical characteristics are similar to those found in cases with typical NAION, not related to glaucoma although in the latter the disc edema tends to be segmental and the altitudinal field defect generally occurs inferiorly.…”

“…The association of NAION with acute glaucoma has been described in only a few reports, Slavin et al (9) in 2001 reported a case of NAION developing in both eyes of a patient that developed sequential acute angle-closure glaucoma; Irak I et al (10) in 2003 described a 41-year-old woman with NAION and glaucomatocyclitic crisis (Posner-Schlossman syndrome) and Nahum Y et al (11) in 2008 described a 59-year-old hyperopic woman with NAION following by a acute angle-closure glaucoma. In these reports, NAION was attributed to an acute IOP rise with resultant perfusion decrease in optic nerve supplying vessels.…”

“…Furthermore, our patient had crowded disc, with bilateral small cup-to-disk ratio which may have contributed for the development of NAION. Although most cases of elevated IOP, including acute angle-closure glaucoma, do not result in optic disc edema and irreversible vision loss, variations in the vascular supply of the nerve optic head along with others ocular systemic risk factors, may predispose certain individuals to NAION during period of elevated IOP (10) . Our patient therefore is important because it serves to emphasize that elevated intraocular pressure may be a precipitating factor for the development of NAION.…”

Posner Schlossman Syndrome

“…7 There are two reports of non-arteriticischaemic optic neuropathy (NAION) associated with PSS attacks. 8,9 Both patients had small optic discs with little or no physiological cupping in the affected eye, which are known risk factors for NAION.…”

Posner‐Schlossman syndrome (glaucomatocyclitic crisis)

“…18 There are two reports of non-arteritic ischaemic optic neuropathy (NAION) associated with PSS attacks. 19,20 Both patients had small optic discs with little or no physiological cupping in the affected eye, which are known risk factors for NAION. 21 …”