Secondary Glaucoma

here are many secondary causes of glaucoma. These can be either of the open angle or closed angle variety, but some cause for the obstruction to aqueous outflow can be determined. These include glaucomas associated with:

1. developmental glaucoma e.g. neurofibromatosis
2. ocular disease e.g. pigment dispersion, neovascular glaucoma
3. systemic diseases & drugs e.g. corticosteroid induced glaucoma
4. inflammation e.g. uveitis
5. trauma e.g. angle recession, RBC associated glaucoma
6. ocular surgery e.g. aphakic glaucoma, aqueous misdirection

Secondary open angle glaucoma

Steroid induced glaucoma

a secondary open angle glaucoma that is due to topical or systemic corticosteroid (glucocorticoid) use

  • 25% of the general population will develop steroid‑induced   increases in IOP after 4 weeks of qid topical steroid drugs
  • 5% of the population are "super-responders" — these patients develop pressure elevations greater than 10 to 15 mm Hg with topical steroid use and may develop a pressure rise within 2 weeks
  • steroid induced glaucoma also occurs with oral steroids but the exact incidence is not well defined
  • topical steroids should not be prescribed unless patient can be monitored by an ophthalmologist for IOP changes

Traumatic glaucoma

  • a hyphema can induce elevation of IOP due to blood blocking trabecular meshwork
  • angle recession glaucoma occurs with blunt, nonpenetrating trauma to globe and orbit, the force of the injury causes tears in the trabecular meshwork and ciliary body with secondary scarring.  Angle recession glaucoma may present years after the inciting injury.

Pigmentary dispersion syndrome (PDS)

  • iris pigment clogs trabecular meshwork
  • this causes a secondary OAG typically in younger myopes

Pseudoexfoliation Syndrome

  • an abnormal basement membrane-like material produced in the eye and clogs the trabecular meshwork
  • this causes a secondary OAG typically in the senior citizenry


Secondary angle closure glaucoma:

  1. Neovascular glaucoma (NVG) — Sturge-Weber Syndrome, diabetes
  2. Uveitis and glaucoma — acute glaucomatocyclitis

© Leo D. Bores, MD, 1996 — 2002