During an attack of acute iridocyclitis the intraocular pressure is often below normal because the production of aqueous by the ciliary body is reduced. When the normal production of aqueous is resumed, it can induce a rise in pressure because the outflow channels have been obstructed by inflammatory exudate. This type of secondary glaucoma responds to vigorous treatment of the iridocyclitis, and here it is essential to dilate and not constrict the pupil and to apply steroid treatment. Acetazolamide and topical beta-blockers, for example timolol and levubunolol, might also be required. The type of secondary glaucoma that develops after the iridocyclitis of herpes zoster infections can be particularly insidious. The intraocular pressure can remain high without obvious pain and with relatively slight inflammatory changes in the eye. Secondary glaucoma usually responds well to treatment and once the underlying inflammation has subsided, the eye returns to normal.
In iridocyclitis, glaucoma can also be caused by pupil block (inability of aqueous to pass from the posterior to anterior chamber) because of posterior synechiae (adhesions between the iris and lens). Treatment is YAG laser iridotomy.
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