Attitudes pratiques: Quand l’hypertension oculaire est unilatérale

Abstract

Certain causes of unilateral ocular hypertension (including glaucoma) are relatively frequent and/or can be problematic at the time of etiological diagnosis. Although the pseudo-exfoliative syndrome is often easily identified by the presence of typical whitish formations on the anterior crystalloid and by the atrophy of the pupillary margin of the iris, it can at times be difficult to recognize (use high magnification, pupillary dilatation, and gonioscopy). The diagnosis of pigmentary dispersion is classically based on the discovery of a Krükenberg spindle and iris transillumination, but these signs may be missing, and the diagnosis can only be made by observation of the anterior hyaloid angle. Questioning the patient can lead to the suspicion of an old ocular contusion, usually confirmed by thorough bilateral gonioscopic observation. Outside of crisis periods, Posner-Schlossman syndrome can only be strongly suspected by the persistence of very fine and rare retrocorneal precipitates visible on high magnification. Iridocorneal endothelial syndromes (causes of unilateral glaucoma by evolutive goniosynechia) affects women from 25 to 50 years of age with no notable antecedent; they evolve more or less rapidly and are expressed in three ways: essential atrophy of the iris and Cogan-Reese disease, with the anatomical features easily identified on the iris, while Chandler disease can only be confirmed by gonioscopy, high-magnification observation of the cornea, and corneal endothelial cell count and analysis.