Posner-Schlossman Syndrome
Recurring episodes of markedly high eye pressure in one eye, with only mild inflammation, that typically return to normal between attacks — but can still cause lasting damage if left unmonitored.
Overview
Posner-Schlossman syndrome, also called glaucomatocyclitic crisis, is an uncommon condition involving recurrent episodes of markedly elevated eye pressure in one eye, accompanied by only mild inflammation inside the eye. Episodes typically last days to a few weeks and then resolve, often with pressure returning to normal between attacks, only to recur again later.
A leading theory for at least a subset of cases points to reactivation of cytomegalovirus (CMV) within the eye, though the condition has been recognized for decades longer than this association has been studied, and the full picture isn't completely settled.
Symptoms
- Mild eye discomfort or a feeling of fullness, rather than severe pain
- Blurred vision and halos around lights during an attack, related to corneal swelling from the high pressure
- Symptoms almost always affecting only one eye at a time
- Episodes that resolve on their own over days to weeks, then may recur later
How Common Is It?
Posner-Schlossman syndrome is considered uncommon, typically affecting adults between about 20 and 50 years of age, and is unilateral (one eye) in the large majority of cases.
The condition tends to run a recurrent course over months to years, sometimes eventually going into lasting remission, though the exact frequency and duration of the overall disease course varies significantly from person to person.
Genetics & Risk Factors
There isn't a well-established inherited pattern for Posner-Schlossman syndrome, though an association with the HLA-Bw54 gene marker has been reported in some populations, particularly in Japan.
The CMV-reactivation theory suggests that, in at least some patients, prior exposure to this common virus (which most adults carry in a dormant form) plays a role in triggering recurrent episodes, similar to how other herpesviruses can reactivate within the eye.
Ocular Findings on Exam
The hallmark finding is a striking mismatch: eye pressure that is often dramatically elevated (commonly in the 40–60 mmHg range) in an eye that looks relatively calm, with only a few inflammatory cells visible in the front chamber and little to no redness.
The drainage angle is open on gonioscopy, and corneal swelling (microcystic edema) from the high pressure may cause mild haziness. The unaffected fellow eye typically looks entirely normal.
Testing & Diagnosis
- Gonioscopy to confirm the angle is open
- Careful slit-lamp grading of anterior chamber inflammation, which is typically mild
- IOP measurement during an active episode, which is often markedly elevated
- Consideration of aqueous humor PCR testing for CMV in recurrent or atypical cases
- OCT and visual field testing to monitor for cumulative optic nerve damage over repeated episodes
Treatment Options
Eye Pressure-Lowering Drops
Aqueous suppressant drops (which reduce fluid production) are typically used during attacks to bring pressure down quickly, and are generally preferred over drops that increase outflow.
Short-Course Topical Steroid
A brief course of mild topical steroid is often used to address the inflammation component, tapered once the episode resolves.
Antiviral Therapy
In patients with confirmed or strongly suspected CMV-associated recurrent disease, oral antiviral medication (such as valganciclovir) may be considered to reduce how often episodes occur.
Long-Term Monitoring
Because repeated episodes over years can eventually damage the optic nerve even though each individual attack resolves, ongoing monitoring between episodes is recommended even when the eye feels and looks normal.
How This Differs From Other Glaucomas
The defining feature that sets Posner-Schlossman syndrome apart from other inflammatory glaucomas is the mismatch between mild inflammation and dramatically high pressure — most uveitic glaucomas involve more visibly inflamed eyes, which is an important diagnostic clue.
It's also episodic rather than chronic: unlike most other glaucomas on this page, pressure typically returns to normal between attacks without ongoing daily treatment, so management is centered on treating individual episodes and monitoring cumulative damage over time, rather than continuous daily therapy.
Frequently Asked Questions
Is this the same as typical uveitic glaucoma?
Not quite. Posner-Schlossman syndrome (also called glaucomatocyclitic crisis) is distinctive because the inflammation is usually mild while the eye pressure spikes dramatically — the opposite pattern from what's typically seen in more inflamed uveitic glaucomas.
What causes it?
The exact cause isn't fully settled, but a leading theory implicates reactivation of cytomegalovirus (CMV) within the eye in at least some patients, particularly those with recurrent episodes.
Will it keep coming back?
It often recurs over months to years, typically in the same eye, though the frequency and severity of attacks vary considerably from person to person, and it may eventually resolve on its own.
Do I need surgery?
Most patients are managed successfully with drops during attacks and don't need surgery, though anyone with frequent or severe recurrent episodes should be monitored for cumulative optic nerve damage over time.
See a glaucoma specialist. Dr. Robert Gunzenhauser is Harvard-educated and UCLA fellowship-trained in glaucoma, providing expert diagnosis and treatment for Posner-Schlossman Syndrome at Inland Glaucoma Center in Upland, CA.