This article is more than 5 years old. Information may no longer be current.

Painful, Red Eye

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

Subscribe

Added to email alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

Back to Healio

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Back to Healio

A patient with previously diagnosed diabetes presents to the ophthalmologist’s office with eye pain and red eye.

Diagnosis

This patient has rubeosis and neovascular glaucoma (NVG) resulting from diabetes and ocular ischemic syndrome (90% stenosis on carotid ultrasound). The photo on the back cover shows extensive rubeosis, ectropion uveae along the temporal pupillary border and broad peripheral anterior synechia nasally.

Early iris and angle neovascularization is often associated with a normal IOP. Once a fibrovascular membrane forms ectropion uveae, anterior synechia and angle closure can develop with a rapid rise in IOP. The membrane can be difficult to visualize; in early stages, the IOP can be elevated with an angle that appears to be open.

Management

Treatment of underlying systemic conditions, such as carotid occlusive disease; panretinal photocoagulation (PRP) for retinal ischemia; aqueous suppressants to control IOP; topical steroids for any inflammatory component; and surgery, preferably filtering surgery or aqueous shunts before cyclodestructive procedures, if useful vision is possible.

Figure 1. Slit Lamp

A. Limbus: closed angle and anterior synechiae.
B. Mid-peripheral iris: partial synechiae and rubeosis.
Source: Odette Callender, MD

Click here for a larger view of this image.

Vascular endothelial growth factor (VEGF) has been implicated as an important factor in the pathogenesis of intraocular neovascularization. Intravitreal anti-VEGF agents may temporarily suppress iris and angle neovascularization allowing PRP to be performed and to take effect.

Caveat: NVG can occur without retinal or disc neovascularization. Frequent monitoring, including gonioscopy, is warranted for those at risk.

References

1. Hayreh SS. Neovascular Glaucoma. Prog Retin Eye Res. 2007;26: 470–485.
2. Neovascular Glaucoma. American Academy of Ophthalmology Web site. http://eyewiki.aao.org/Neovascular_Glaucoma#Signs. Accessed July 21, 2011.