Glaucoma secondary to eye inflammation (uveitic glaucoma)

The NHS describes glaucoma as an eye condition where the main nerve connecting the eye to the brain becomes damaged, usually caused by a build-up of pressure when the fluid in the eye cannot drain as it should. It lists secondary glaucoma as a type that is usually caused by another condition or eye injury. Moorfields adds that secondary glaucoma occurs as a result of an eye injury or another eye condition, such as uveitis (inflammation of the middle layer of the eye).

NICE CKS classifies glaucoma by cause as primary (no known cause) or secondary, and by the angle between the iris and cornea as open or closed. In uveitis, RNIB lists raised eye pressure as a complication, and the Dudley Group leaflet says steroid treatment can raise it too. Care therefore involves both controlling the inflammation and keeping an eye on pressure and the optic nerve.

The NHS says uveitis is a rare condition causing inflammation inside the eye, and that early treatment avoids long-term complications such as vision loss. RNIB lists raised eye pressure among the complications of uveitis. It says good control of inflammation lowers the risk of complications, and that although uveitis treatments can have side effects and need monitoring, controlling the uveitis properly gives a much better outcome for sight than under-treating it.

The Dudley Group leaflet explains that steroid eye drops can cause high pressure in the eye, early cataracts and a higher risk of eye infection, and that steroid tablets can also be linked with glaucoma and cataract among other side effects. Your eye team will usually want to monitor this. The NHS also lists being over 50, having a close relative with glaucoma, African, Caribbean or Asian background and having conditions such as short or long sight or diabetes as general glaucoma risk factors.

The NHS says glaucoma does not usually have symptoms, develops slowly over many years and is usually picked up during routine eye tests. Moorfields says it tends to affect peripheral vision first. Occasionally pressure rises suddenly and the NHS lists intense eye pain, a red eye, tenderness around the eyes, rainbow-coloured circles around lights, blurred vision, nausea and vomiting, and headache.

Uveitis itself causes eye pain, redness, sensitivity to light, blurred or cloudy vision and floaters, according to the NHS and the Dudley Group leaflet. Because the NHS says glaucoma does not usually have symptoms, a rise in pressure may not be felt, which is why follow-up appointments matter even when the eye feels well.

The NHS says to call 999 or go to A&E if you develop symptoms of glaucoma suddenly, as this is a medical emergency that may require immediate treatment. For uveitis, the NHS says to ask for an urgent GP appointment or get help from NHS 111 for eye pain, sensitivity to light, changes in vision or very red eyes, and to go to A&E or call 999 if you cannot see. The Dudley Group leaflet says that if symptoms get worse or new symptoms appear, advice should be sought immediately from the eye clinic.

Glaucoma is usually found during a routine eye test. The NHS says that if you are told you have it you will be referred to an ophthalmologist for further tests. NICE CKS describes glaucoma as characterised by visual field defects and changes to the optic nerve head, commonly with raised intraocular pressure. For uveitis patients, review appointments check how treatment is working, look for side effects and check for complications such as vision loss, according to the NHS.

The Dudley Group leaflet notes that your pupils may be dilated at visits so you should not drive yourself, and that you should not miss clinic appointments even if the eye feels recovered.

The NHS says there is currently no cure for glaucoma but treatments can slow damage and help stop vision getting worse: eye drops to decrease the amount of fluid in the eye and help it drain, laser treatment, and several different types of operation. Follow-up appointments monitor how treatment is working.

In uveitic glaucoma, treatment has two aims. The inflammation is controlled with steroids and, where needed, immune-suppressing medicines, which RNIB describes, and pressure is lowered with glaucoma treatment. Because steroids can themselves raise pressure, your specialist weighs the need to control inflammation against that risk. Do not stop or change steroid drops yourself: the Dudley Group leaflet advises not to stop drops or tablets suddenly, even if the eye feels fine, as symptoms may come back.

The NHS says that if glaucoma is diagnosed and treated early it may not change vision much, but sometimes sight is affected and in rare cases may be lost. It says that for many people this means daily eye drops and regular clinic appointments, and describes support from charities such as Glaucoma UK and RNIB for people with sight loss. NICE CKS says the main complication of untreated glaucoma is irreversible loss of vision, and that appropriate treatment reduces the risk of progression.

Uveitis and glaucoma are managed by hospital eye services,. Private eye clinics can provide the same types of assessment and treatment. Because two conditions are involved, it helps to ask which clinician is coordinating the inflammation treatment and which is monitoring the pressure and optic nerve, and how they share results.