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The Enigma of Posner-Schlossman Syndrome: The Transient Strome

by | Feb 1, 2026 | Manuscripts | 0 comments

Tilottama Basnet, B. Optom Student

Acharya Institute of Allied Health Sciences, Bengaluru, India

 

Posner-Schlossman Syndrome (PSS), also referred to as glaucomatocyclitic crisis, is a rare ocular disorder marked by abrupt, unilateral, repeated episodes of rise in Intraocular Pressure (IOP) and mild anterior chamber inflammation. (1) Adults between the ages of 20 to 50 years old are usually affected by PSS. (2) The pathophysiology is still unknown, although several theories have been proposed, ranging from autoimmune to infectious. (3)
 

PSS and Visual Challenges

Although Cytomegalovirus (CMV) infection is assumed to be linked to PSS, different investigations have found different prevalence and characteristics of CMV infection in PSS patients. (1)

A systematic review and meta-analysis of twenty-one studies, enrolling 1265 patients with PSS, reported that the pooled prevalence of CMV infection in patients with PSS was 44.5 %. The affected eye in patients with CMV infection had significantly lower endothelial density (mean difference − 389.8 cells/mm2). (2)

A study conducted a preliminary clinical report of alternate episodes of PSS and viral keratitis and found that both share the characteristic of being prone to recurring bouts at varying intervals. (3)

Parameters Signs
Intraocular Pressure (IOP) Elevated during attack (30-70mmHg)
Cornea Fine Keratic Precipitates (KPs)
Anterior chamber Open angle, mild cells, and flares
Optic disc Normal during attack

Table 1: Table showing clinical findings in PSS

Figure 1: Image showing Slit Lamp Examination of a Patient Undergoing Slit Lamp Examination – A Critical Step In Differential Diagnosis

Image Courtesy https://www.freepik.com/free-photo/medium-shot-woman-getting-her-eyes-checked_

Early Detection and Management

The treatment strategy includes medical care, surgery, frequent observation, and detection of the causative aetiology. The management of the condition is mainly medical reduction of the IOP with the best available topical anti-glaucoma drugs.

Secondly, mild topical corticosteroid drops are used to contain inflammation because the inflammatory response is usually mild. This is deemed to have surgical management when IOP and visual field defects are poorly treated with medical therapy, but the method of trabeculectomy with added Mitomycin-C is the most favoured choice.

It is necessary to have a protocol of regular monitoring, which includes follow-ups daily until the IOP returns to normal, and then regular follow-ups are necessary. It is important to identify the underlying aetiology, and the patients must undergo screening for viral infections like Cytomegalovirus (CMV) and Herpes Simplex Virus (HSV).

Antiviral therapy using oral valganciclovir or topical ganciclovir is recommended in cases of CMV infection.
 

Beyond Treatment

PSS therapy methods are constantly evolving, and many sophisticated techniques affect management. Here is a closer look at how innovative treatments and diagnostics are changing eye care beyond PSS:

  • Molecular diagnosis and viral profiling: PCR (Polymerase Chain Reaction) analysis of aqueous humour helps to detect CMV and herpes. (3)
  • Neuroprotective agents: To preserve retinal ganglion cells in chronic IOP elevation cases. (3)
  • Gonioscopy-Assisted Transluminal Trabeculotomy (GATT): Invasive technique for PSS with uncontrolled IOP. (3)

 

Conclusion

PSS is a silent catastrophe in which IOP rises and inflammation murmurs. (1) The long-term outlook is generally positive; however, there is a considerable chance of irreversible visual field loss due to recurrent recurrences and protracted disease duration. PSS should be differentiated from Herpetic Anterior Uveitis (HAU), Fuchs’ Heterochromic Iridocyclitis (FHI), and secondary glaucoma. Early detection and diagnosis are the keys, and timely intervention is crucial.

References

  1. Murata, K., Ishida, K., Ozawa, K., Sawada, A., Mochizuki, K., & Yamamoto, T. (2019). The characteristics of Posner-Schlossman syndrome: A comparison in the surgical outcome between cytomegalovirus-positive and cytomegalovirus-negative patients. Medicine, 98(48), e18123.
  2. Lee, S. H., Ho, Y. R., Li, H., Tu, Y. K., Bowman, K., Chou, E. H., … & Tsai, T. Y. (2025). Prevalence and clinical manifestations of cytomegalovirus infection in patients with Posner-Schlossman syndrome:
    A systematic review and meta-analysis. Survey of Ophthalmology.
  3. Sun, Z., Cao, D. M., Zhang, Y., & Zhou, H. Z. (2022). Preliminary clinical report of alternate episodes of Posner–Schlossman syndrome and viral keratitis. Transplant Immunology, 74, 101673.
  4. Yu, L., Zhang, L., He, L., Cui, K., & Wu, Q. (2023). The Incidence and Risk Factors of Optic Nerve Damage of Posner-Schlossman Syndrome: A Meta-Analysis. Alternative Therapies in Health & Medicine, 29(8).

 

 

About the Author

Tilottama Basnet

B. Optom Student
Acharya Institute of Allied Health Sciences, Bengaluru, India

 

 

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