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Secondary glaucomas
In secondary glaucoma there is an identifiable cause of the raised pressure — material clogging the trabecular meshwork (pigment, pseudoexfoliation material, lens protein, blood cells), tissue pulling the angle shut (new vessels, inflammation) or raised venous pressure — and treatment must target the cause, not only the pressure.
Why it matters in the exam
The exam gives one sign that identifies the type. Pseudoexfoliation: white flaky material on the pupil margin and the lens capsule, linked to the LOXL1 gene, high and fluctuating pressures, a worse prognosis than primary disease, and weak zonules that complicate cataract surgery. Pigment dispersion: a young myopic man, pigment on the endothelium in a vertical spindle (Krukenberg spindle), mid-peripheral iris transillumination defects, dense angle pigment and pressure spikes after exercise.
Neovascular glaucoma results from retinal ischaemia — ischaemic central retinal vein occlusion (the "100-day glaucoma"), proliferative diabetic retinopathy or ocular ischaemic syndrome from carotid stenosis — and vessels on the pupil margin and in the angle gradually close it. Treatment: immediate intravitreal anti-VEGF, PRP to reduce the ischaemia, then a drainage device or cyclophotocoagulation. Steroid-induced glaucoma appears after 2–6 weeks of drops, injection or systemic therapy, and pressure usually returns to normal when the steroid is stopped.
Other types that are asked: Posner-Schlossman — unilateral attacks of very high pressure with mild inflammation and few keratic precipitates, linked to CMV; phacolytic glaucoma — a hypermature cataract leaking protein, an open angle and macrophages in the chamber; angle recession — after blunt trauma, sometimes years later, when more than 180 degrees of the angle were torn; ghost cell — after vitreous haemorrhage; aqueous misdirection — after surgery, a shallow chamber centrally and peripherally with high pressure; Sturge-Weber — raised episcleral venous pressure.
Key points
- Secondary glaucoma = an identifiable cause that blocks or pulls the angle.
- Pseudoexfoliation: white material, LOXL1, high pressures, weak zonules.
- Pigment dispersion: young myopic man, Krukenberg spindle.
- Neovascular: anti-VEGF, PRP and a drainage device.
- Steroids raise pressure after 2–6 weeks.
Summary table
| Type | Identifying sign | Main treatment |
|---|---|---|
| Pseudoexfoliation | White material on the lens capsule, LOXL1 | Drops, SLT, earlier surgery; caution in cataract surgery |
| Pigment dispersion | Krukenberg spindle, iris transillumination defects, myopia | Drops, low-energy SLT |
| Neovascular | Vessels on the iris and in the angle after CRVO or PDR | Anti-VEGF, PRP, drainage device |
| Steroid-induced | Rise after 2–6 weeks of a steroid | Stop or switch, drops |
| Phacolytic | Hypermature cataract, open angle | Lower pressure and remove the lens |
| Aqueous misdirection | Uniformly shallow chamber after surgery, high pressure | Cycloplegia, drops, vitrectomy |
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Sources
- European Glaucoma Society: Terminology and Guidelines for Glaucoma, 5th edition (2020) — Secondary glaucomas
- AAO Basic and Clinical Science Course, Section 10: Glaucoma, 2024-2025 — Secondary open-angle and angle-closure glaucoma
- Kanski's Clinical Ophthalmology, 9th edition (2020) — Glaucoma
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.