UGH Syndrome (Uveitis-Glaucoma-Hyphema)
A recurring triad of inflammation, high eye pressure, and bleeding inside the eye — usually traced to a lens implant that is rubbing against nearby tissue after cataract surgery.
What Is UGH Syndrome?
UGH syndrome — short for Uveitis-Glaucoma-Hyphema — describes a recurring triad of three problems occurring together inside the eye: inflammation (uveitis), raised eye pressure (glaucoma), and bleeding (hyphema). It is a type of secondary glaucoma, meaning it is caused by another identifiable problem rather than arising on its own. In the large majority of cases, that underlying problem is an artificial lens implant that is not sitting quite right after cataract surgery.
What Causes It
The eye's iris is delicate, richly supplied with tiny blood vessels, and sits just in front of where an intraocular lens (IOL) is placed during cataract surgery. If that lens implant is tilted, loose, off-center, placed in the wrong position (for example, in the ciliary sulcus rather than the capsular bag), or simply the wrong size for the eye, its firm edge or supporting arm can rub repeatedly against the back of the iris or against the eye's drainage angle.
That repetitive mechanical chafing sets off all three parts of the syndrome at once: it tears tiny iris blood vessels, releasing blood into the eye (the hyphema); it irritates the tissue, producing chronic inflammation (the uveitis); and the resulting mix of blood, pigment, and inflammatory cells clogs the trabecular meshwork — the eye's drainage filter — while inflammation further reduces outflow, driving eye pressure up (the glaucoma). Older anterior-chamber lens designs were classically associated with UGH, but it can occur with several lens types and positions.
Signs & Symptoms
A hallmark of UGH syndrome is that symptoms tend to come and go rather than stay constant, which can make it easy to dismiss early on. Patients — typically at some point after cataract surgery — may notice:
- Episodes of blurred vision, sometimes with a reddish or pink tint from blood in the eye
- Eye redness, aching, or a dull pressure sensation
- Light sensitivity during flare-ups
- Brief episodes of worse vision or halos when eye pressure spikes
- A pattern of symptoms that flare, settle, and then recur
On examination, a glaucoma specialist may find inflammatory cells and pigment floating in the front of the eye, a small layer or wisp of blood (microhyphema or hyphema), elevated eye pressure, transillumination defects where the iris has been chafed, and, on careful evaluation or imaging, a lens implant that is tilted or making contact with the iris.
How It's Diagnosed
Diagnosis combines a careful history — particularly a history of cataract surgery and recurring episodes — with a detailed slit-lamp examination, eye pressure measurement, and gonioscopy to inspect the drainage angle for blood or pigment. Because the culprit is usually a lens implant that is contacting the iris, imaging such as ultrasound biomicroscopy (UBM) or anterior-segment OCT is often used to see exactly how the lens is positioned and where it is touching. Documenting the optic nerve and visual field establishes whether any glaucoma damage has already occurred.
Treatment
Treatment works on two fronts at the same time — calming the eye now, and correcting the underlying cause so the cycle stops.
Control the inflammation and pressure
Anti-inflammatory (steroid) eye drops settle the uveitis, pressure-lowering drops or oral medication bring the eye pressure down, and, when there is significant bleeding, additional measures may be used to help it clear. This stabilizes the eye but does not fix the mechanical problem on its own.
Correct the underlying cause
Because the root problem is usually a lens implant that is rubbing, the definitive treatment is a surgical procedure to reposition, exchange, or remove the offending IOL so it no longer contacts the iris. Removing the source of chafing is what breaks the recurring cycle of inflammation, pressure, and bleeding.
Manage any lasting glaucoma
If repeated pressure spikes have already caused optic nerve damage, that glaucoma is then managed on its own — with drops, laser, or surgery as needed — even after the lens issue is corrected. See our Treatments pages for how these options work.
The takeaway: recurring inflammation, high pressure, or bleeding in an eye that has had cataract surgery deserves a careful look by a glaucoma specialist. UGH syndrome is very treatable, but the key is identifying and correcting the mechanical cause before it does lasting harm to the optic nerve.
Frequently Asked Questions
What is UGH syndrome?
UGH stands for Uveitis-Glaucoma-Hyphema. It is a syndrome in which an intraocular lens implant (or, less often, another structure) mechanically rubs against the iris, producing a recurring combination of inflammation inside the eye (uveitis), elevated eye pressure (glaucoma), and bleeding (hyphema).
What causes UGH syndrome?
The most common cause is a malpositioned, tilted, loose, or poorly sized intraocular lens (IOL) after cataract surgery. The edge or supporting arm (haptic) of the lens chafes against the back of the iris or the drainage angle, damaging small blood vessels and releasing pigment and inflammatory cells.
What are the symptoms of UGH syndrome?
Symptoms are often intermittent and include episodes of blurred or red-tinted vision, eye redness, aching or light sensitivity, and transient vision changes when eye pressure spikes. Because it tends to flare and settle, it can be mistaken for ordinary post-operative inflammation at first.
How is UGH syndrome treated?
Treatment has two parts: controlling the inflammation and eye pressure with medications, and addressing the root cause. When a lens implant is responsible, the definitive treatment is surgically repositioning, exchanging, or removing the lens so it no longer rubs. Any lasting glaucoma damage is then managed on its own.
Can UGH syndrome cause permanent damage?
Yes, if it is not treated. Repeated pressure spikes can permanently damage the optic nerve, and recurrent bleeding and inflammation can harm the eye. This is why prompt evaluation by a glaucoma specialist matters when these episodes keep recurring after cataract surgery.
See a glaucoma specialist. Dr. Robert Gunzenhauser is Harvard-educated and UCLA fellowship-trained in glaucoma, providing expert diagnosis and treatment for UGH Syndrome (Uveitis-Glaucoma-Hyphema) at Inland Glaucoma Center in Upland, CA.