Synopsis
Identify the cause of secondary pressure elevation, distinguish open-angle obstruction from secondary closure, and coordinate pressure control with treatment of the underlying ocular disorder.
- Secondary glaucoma means optic nerve injury associated with an identifiable ocular disease, treatment or injury; isolated secondary ocular hypertension does not yet establish glaucoma.
- Inspect the cornea, iris, lens and angle as well as the optic nerve; pressure measurement alone cannot identify the cause.
- Pigment dispersion and pseudoexfoliation can obstruct outflow while the angle remains open, whereas neovascular membranes or secondary displacement can close it.
Key red flags
A painful high-pressure eye with iris neovascularisation after retinal vein occlusion or proliferative diabetic retinopathy needs urgent retinal and glaucoma assessment to address both ischaemia and pressure.
Investigation priorities
Assess current threat and identify a painful secondary emergency.
Management branches
Raised pressure or optic neuropathy is accompanied by an unusual ocular history or anterior segment finding.
- Assess immediate visual threat and examine the angle and anterior segment for pigment, exfoliation, inflammation, vessels and structural injury.
- Review medicines, including non-ocular steroids, and obtain the timing of trauma, surgery, retinal events and previous pressure measurements.
Key medicines
Dorzolamide 20 mg/mL eye dropsUse one drop in each treated eye three times daily as monotherapy; when used as an adjunct to an ophthalmic beta-blocker, the selected product specifies one drop twice daily. Continue until a planned pressure review or a revised prescription.