Posner and Shlossman syndrome: Case report and literature review

Posner-Schlossman syndrome (PSS), also known as glaucomatocyclitic crisis, is a rare ocular condition characterized by recurrent, unilateral episodes of elevated intraocular pressure (IOP) accompanied by mild, idiopathic anterior uveitis. First described in 1948, its etiology remains uncertain, with factors such as viral infection, autoimmune response, and genetic predisposition being proposed. PSS typically affects adults between ages 20 and 50, presenting with blurred vision, minimal anterior chamber inflammation, and significant IOP elevation, often out of proportion to the degree of inflammation. Diagnosis relies on clinical findings, and management focuses on controlling both the inflammatory response and IOP, primarily through topical anti-inflammatory and anti-glaucoma medications. In refractory or recurrent cases, surgical intervention may be necessary. While the condition is self-limiting in most cases, recurrent attacks can lead to glaucomatous optic nerve damage over time, underscoring the importance of long-term monitoring and individualized patient care. We report a case of 48-year-old patient presented with a sudden onset of painful, red right eye and decreased visual acuity. Examination revealed significantly elevated intraocular pressure (48 mmHg), corneal edema, fine white retrodescemetic precipitates, semi-mydriasis, and minimal anterior chamber inflammation, with a normal optic disc and open angles; the left eye was unremarkable. Initial management with intravenous mannitol, topical beta-blocker and carbonic anhydrase inhibitor, and oral acetazolamide provided limited pressure control, requiring the addition of topical alpha-adrenergic therapy. Once intraocular pressure normalized, persistent anterior uveitis was managed with local corticosteroids, resulting in resolution of inflammatory signs. This case highlights the importance of individualized, stepwise management in Posner-Schlossman syndrome to address both intraocular pressure elevation and anterior uveitis.