Posner-Schlossman syndrome: when initial topical anti-hypertensive therapy has not controlled intraocular pressure at one week

This protocol addresses the next clinical step after the standard first-line topical regimen for Posner-Schlossman syndrome has been assessed at one week and found not to have achieved the expected reduction in intraocular pressure and intraocular inflammation.

Previous line — failure condition

Initial treatment consisted of topical anti-inflammatory and anti-hypertensive therapy to the affected eye. At the one-week reassessment, the goals of reducing intraocular pressure and intraocular inflammation in the affected eye had not been reached. This non-achievement is the trigger for escalation to the intensified approach described here.

Next-line approach (partial overview)

The escalated step involves intensified anti-hypertensive therapy for the affected eye — combining topical agents with an oral pressure-lowering agent, followed by a structured transition in the regimen once pressure responds. The complete sequence, agents, and transition criteria are set out in the full protocol.

Clinical goals

Reduction of intraocular pressure in the affected eye, with resolution of corneal oedema, reassessed within approximately one day to two weeks.

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References

DOI: 10.1111/j.1444-0938.2006.00088.x

The patient's medications were changed to dorzolamide 2.0% and brimonidine 0.2% bid.
Additionally he was prescribed acetazolamide 500 mg orally bid.
Fluorometholone 0.1% bid was added and acetazolamide was discontinued.
On the following day, the pressure in the right eye had fallen to 28 mmHg and the cornea was free of oedema.
Two weeks later, the right IOP was 15 mmHg.

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