Posner–Schlossman Syndrome (PSS), also known as glaucomatocyclitic crisis, is a rare eye condition marked by sudden, temporary spikes in pressure inside one eye (intraocular pressure, or IOP) alongside mild inflammation of the eye’s front chamber. In very simple terms, the pressure inside the affected eye goes up quickly, making the eye feel uncomfortable, but the inflammation is usually gentle and does not cause severe redness or pain. Between attacks, people often feel normal and may not notice any ongoing eye problems WikipediaPubMed.
Posner–Schlossman syndrome (PSS), also called glaucomatocyclitic crisis, is a rare eye condition characterized by sudden, one-sided spikes in pressure inside the eye (intraocular pressure, or IOP) along with mild inflammation in the front part of the eye. People often have blurred vision, see colored halos around lights, or feel mild discomfort rather than severe pain. Each attack may last hours to weeks and tends to recur in the same eye. Over time, repeated episodes can damage the optic nerve and lead to glaucoma if not managed properly EyeWikiNCBI.
PSS was first described in 1948 by Drs. Posner and Schlossman, who observed a series of patients with these sudden pressure rises without the usual closing of the eye’s drainage angles. Today, doctors still focus on relieving pressure and calming inflammation during each acute episode to protect vision over the long term MD SearchlightEyeWiki.
Types
Although PSS is often classified simply as “idiopathic” (of unknown cause), clinicians recognize several types based on likely triggers:
Idiopathic PSS: The most common form, where no clear cause is found despite tests. Attacks happen on their own, and the eye returns to normal between episodes. Wikipedia
Infectious PSS: When laboratory tests find a virus (like cytomegalovirus or herpes simplex) in the eye’s fluid, suggesting an infection may trigger attacks. PubMed
Autoimmune-associated PSS: Linked to certain immune markers, such as HLA-Bw54, hinting the body’s immune system may play a role. Wikipedia
Secondary PSS: Extremely rare cases occur after eye surgery, injury, or even following certain injections into the eye. NCBI
Causes
Researchers have proposed many theories and factors that might lead to PSS. Here are 20 potential causes, each explained simply:
Unknown (Idiopathic) – No identifiable reason after a full eye check Wikipedia
Autonomic Nerve Imbalance – Small nerves that control eye fluid balance may act up, causing pressure to rise NCBI
Allergic Reaction – An unusual allergy in the eye tissues might trigger mild inflammation and pressure spikes MD Searchlight
Developmental Glaucoma Variant – A slight, built-in difference in how the eye drains fluid from birth ScienceDirect
Abnormal Ciliary Blood Flow – The tiny blood vessels around the fluid-producing part of the eye may leak or constrict oddly NCBI
Autoimmune Response – The body’s own defenses mistakenly attack parts of the eye, leading to inflammation Wikipedia
Cytomegalovirus (CMV) Infection – CMV virus found in eye fluid can inflame the front chamber PubMed
Herpes Simplex Virus (HSV) Infection – A common cold-sores virus detected in some PSS cases PubMed
Varicella Zoster Virus (VZV) – The same virus that causes chickenpox or shingles can re-activate in the eye PubMed
Helicobacter pylori Infection – A stomach germ sometimes linked to eye inflammation Wikipedia
Borrelia burgdorferi (Lyme Disease) – Rarely, the tick-borne bacteria shows up in eye fluid tests Wikipedia
Epstein–Barr Virus (EBV) – Virus known for “mono” that can inflame eye tissues in rare cases NCBI
Mumps Virus – Once a common childhood infection, now rare, but seen in some reports Glaucoma Today
Ocular Trauma – Injury to the eye can disturb fluid balance and cause PSS-like attacks WebEye
Cataract Surgery – A small number of patients develop pressure spikes after lens surgery ClinicalTrials.gov
Laser Vision Correction – Procedures like LASIK may trigger inflammation in very rare cases MD Searchlight
Glaucoma Filtering Surgery – Surgery to lower pressure sometimes leads to rebound PSS episodes NCBI
Intraocular Injections – Medicines injected into the eye can irritate tissues and cause PSS-like signs ClinicalTrials.gov
Steroid Withdrawal – Stopping strong anti-inflammatory drops suddenly may allow pressure to surge Glaucoma Today
Genetic Predisposition – Family patterns hint some genes might increase PSS risk Wikipedia
Symptoms
During an acute PSS attack, a person may notice:
High Eye Pressure – A sudden feeling of pressure or fullness inside the eye as IOP rises between 30–70 mmHg Wikipedia
Mild Eye Pain – A dull ache rather than sharp pain EyeWiki
Blurred Vision – Things look fuzzy or out of focus EyeWiki
Colored Halos – Rings around lights, especially at night Review of Optometry
Mild Redness – Slight pinkness, but not the deep red of a bad infection Review of Optometry
Photophobia – Lights feel too bright or uncomfortable EyeWiki
Gritty Sensation – Like sand or dust under the eyelid NCBI
Headache – A mild ache around the eye or brow Glaucoma Today
Peripheral Blur – Side vision may dim slightly Wikipedia
Conjunctival Injection – Tiny blood vessels visible on the white of the eye Review of Optometry
Keratitic Precipitates – Small white spots on the inner cornea seen with a microscope Review of Optometry
Aqueous Cells and Flare – Inflammatory cells and proteins floating in front eye fluid EyeWiki
Open Angles – Drainage channels remain open even during attacks Review of Optometry
No Posterior Synechiae – Iris does not stick to lens, unlike some uveitis Review of Optometry
Normal Between Attacks – No ongoing discomfort or vision change when pressure drops back Wikipedia
Diagnostic Tests
Physical Exam
Visual Acuity Test – Checks how well you read letters on a chart at a set distance Wikipedia
Tonometry (Goldmann or Applanation) – Measures eye pressure by gently touching the cornea NCBI
Slit-Lamp Examination – Uses a bright microscope to look at front eye structures EyeWiki
Gonioscopy – Views the drainage angle with a special lens on the eye EyeWiki
Fundoscopy (Ophthalmoscopy) – Examines the optic nerve at the back of the eye NCBI
Manual Tests
Schiøtz Tonometry – Another device that measures eye pressure via indentation of the cornea NCBI
Pupil Reaction Test – Checks how pupil size changes with light to rule out other conditions Review of Optometry
Corneal Thickness (Pachymetry) – Measures cornea thickness, which can affect pressure readings EyeWiki
Lab and Pathological Tests
Aqueous Humor PCR for CMV, HSV, VZV – Detects viral DNA in eye fluid PubMed
Serology for CMV IgM/IgG – Blood test for recent or past CMV infection PubMed
HLA-Bw54 Typing – Genetic marker linked to autoimmune PSS Wikipedia
Complete Blood Count (CBC) – General health check for infection signs NCBI
ESR/CRP – Inflammation markers in blood NCBI
Electrodiagnostic Tests
Pattern Electroretinography (PERG) – Tests retinal cell function under patterns Wikipedia
Visual Evoked Potentials (VEP) – Measures brain response to visual signals Wikipedia
Imaging Tests
Optical Coherence Tomography (OCT) – Cross-sectional images of retina and front chamber EyeWiki
Ultrasound Biomicroscopy (UBM) – High-resolution ultrasound of front eye structures NCBI
Anterior Segment OCT – Detailed images of the drainage angle and cornea EyeWiki
Non-Pharmacological Treatments
Many lifestyle and complementary approaches can help support eye health and may modestly reduce IOP or improve overall well-being during PSS episodes. While these should never replace medical therapy, they can be valuable add-ons.
Acupuncture, Meditation, and Yoga. Traditional Chinese acupuncture at periorbital points has shown small but measurable IOP reductions in glaucoma patients; meditation and gentle yoga (avoiding head-lowering poses) may lower stress-related cortisol spikes that can raise eye pressure EyeWikiGlaucoma Today.
Sleep Posture and Hygiene. Elevating the head of the bed by about 20° can limit overnight IOP elevations. Good sleep habits—consistent bedtimes, darkened room, and no screens before bed—help regulate blood pressure and stress hormones linked to pressure fluctuations EyeWikiGlaucoma Research Society of Canada.
Exercise and Smoking Cessation. Regular moderate exercise improves blood flow to the eye and body, aiding pressure control. Quitting smoking enhances surgical outcomes and overall eye health, as tobacco toxins can worsen vascular function in the eye Glaucoma Research Society of CanadaEyeWiki.
Weight, Blood Pressure, and Hydration. Maintaining a healthy weight and stable blood pressure reduces systemic stress on eye vessels. Limiting excess caffeine and alcohol, and staying well-hydrated, prevents sudden IOP changes from fluid shifts in the body Glaucoma Research Society of CanadaEyeWiki.
Ergonomics and Protective Eyewear. Proper screen positioning reduces eye strain and transient pressure spikes. Outside, wear wraparound sunglasses blocking 99–100% of UV-A and UV-B rays to protect ocular tissues from light-induced inflammation. In windy or dusty conditions, use protective goggles to prevent irritation that can trigger mild uveitic flares American Academy of OphthalmologyWikipedia.
Drug Treatments
When a PSS attack occurs, quick-acting medications are essential to lower IOP and calm inflammation.
Prednisolone Acetate (1%) is a topical steroid that reduces uveal inflammation; typically one drop every hour initially, then tapered based on response. Side effects include cataract risk and steroid-induced pressure rises WikipediaEyeWiki.
Ketorolac Tromethamine (0.5%) is a nonsteroidal anti-inflammatory eye drop given four times daily to spare steroids; it blocks prostaglandin production with fewer pressure-raising risks WikipediaEyeWiki.
Timolol Maleate (0.5%) is a beta-blocker administered twice daily; it decreases aqueous humor production. Contraindicated in asthma and heart block; watch for bradycardia and low blood pressure WikipediaEyeWiki.
Brimonidine Tartrate (0.15–0.2%) is an alpha-2 agonist used two to three times daily; it reduces fluid production and may boost drainage. Side effects include dry mouth and fatigue WikipediaEyeWiki.
Acetazolamide (250 mg) is an oral carbonic anhydrase inhibitor given one to two times daily; it quickly lowers IOP but can cause tingling, kidney stones, and metabolic acidosis WikipediaEyeWiki.
Dorzolamide (2%) topical carbonic anhydrase inhibitor used three times daily; lowers fluid formation with fewer systemic effects than oral forms WikipediaEyeWiki.
Latanoprost (0.005%) is a prostaglandin analog given once nightly; it enhances outflow through the uveoscleral pathway. Side effects include iris darkening and eyelash changes WikipediaEyeWiki.
Pilocarpine (1–2%) is a muscarinic agent instilled two to four times daily; it increases trabecular meshwork outflow. Watch for headaches and brow ache WikipediaEyeWiki.
Mannitol (20%) is an intravenous hyperosmotic agent used in emergencies; it dehydrates the vitreous and quickly lowers IOP. Side effects include electrolyte imbalance and dehydration WikipediaEyeWiki.
Apraclonidine (0.5–1%) is an alpha-2 agonist used three times daily for acute IOP spikes; it reduces fluid production with short-term use to avoid tachyphylaxis WikipediaEyeWiki.
Dietary Molecular Supplements
Certain nutritional supplements may help modulate IOP or protect retinal cells when used alongside standard treatments.
Omega-3 Fatty Acids. Daily oral supplementation for three months has been shown to lower IOP in normotensive adults by about 8% PMCPrevention.
Lutein and Zeaxanthin. These carotenoids accumulate in the retina, filter blue light, and protect against oxidative stress; typical doses are 10 mg lutein and 2 mg zeaxanthin daily PreventionFrontiers.
Vitamin C (500 mg) acts as an antioxidant in the aqueous humor, reducing free radicals that can damage trabecular cells PreventionFrontiers.
Vitamin E (200 IU) supports cell membrane integrity in ocular tissues and may help maintain drainage function PreventionFrontiers.
Curcumin (500 mg) from turmeric has anti-inflammatory and antioxidant effects that may benefit chronic uveitic processes PreventionFrontiers.
Bilberry Extract (160 mg) contains anthocyanins that improve capillary strength and retinal microcirculation PreventionFrontiers.
Ginkgo Biloba (120 mg) enhances ocular blood flow and offers neuroprotective antioxidant effects when taken daily PreventionFrontiers.
Magnesium (300 mg) supports vascular tone and may improve ocular perfusion in patients with vascular dysregulation PreventionFrontiers.
Alpha-Lipoic Acid (600 mg) regenerates other antioxidants and can protect retinal ganglion cells from oxidative damage PreventionFrontiers.
Resveratrol (250 mg) has anti-inflammatory and vasodilatory properties that may support optic nerve health PreventionFrontiers.
Regenerative and Immunomodulatory Drugs
Emerging therapies aim to target underlying immune and viral triggers or harness regenerative cells.
Topical or intravitreal Ganciclovir (0.15% gel or 2 mg/mL injection) treats CMV-associated PSS attacks, reducing viral load in the anterior chamber NCBIWikipedia.
Oral Valganciclovir (900 mg twice daily) offers systemic CMV suppression for recurrent viral-triggered cases NCBIWikipedia.
Biologic Infliximab (5 mg/kg IV) and Adalimumab (40 mg SC every other week) have been explored for refractory immune-mediated uveitis, potentially benefiting PSS with autoimmune features NCBIWikipedia.
Netarsudil (0.02% nightly) is a Rho-kinase inhibitor that enhances trabecular outflow and shows promise in chronic pressure control NCBIWikipedia.
Mesenchymal Stem Cell Therapy (experimental intravitreal injection) aims to regenerate damaged trabecular meshwork and protect retinal ganglion cells in early trials NCBIWikipedia.
Surgical Options
When medical and adjunctive measures cannot control IOP, minimally invasive glaucoma surgeries (MIGS) or filtering procedures are considered.
Trabeculectomy creates a new drainage channel under the conjunctiva to lower IOP.
Glaucoma Drainage Implant (tube shunt) directs fluid to an external reservoir.
Argon Laser Trabeculoplasty uses laser burns to open drainage channels in the trabecular meshwork.
Selective Laser Trabeculoplasty (SLT) selectively targets pigmented cells in the drainage tissue to improve outflow with less tissue damage.
Cyclophotocoagulation applies laser energy to reduce aqueous humor production by partially ablating ciliary body tissue EyeWikiWikipedia.
Preventions
While no guaranteed way exists to prevent PSS entirely, certain measures may reduce attack frequency or severity.
Stress Management. Reducing emotional stress through therapy or mindfulness may lower cortisol-mediated IOP spikes.
Avoid Head-Down Postures. Refrain from yoga inversions and activities that significantly tilt the head below the heart.
Protective Eyewear. Use UV-blocking sunglasses to limit light-induced ocular inflammation.
No Eye Rubbing. Prevent mechanical irritation that can trigger mild uveitic responses.
Manage Infections. In CMV-associated cases, consider prophylactic antiviral therapy under specialist guidance NCBIWikipedia.
Regular Eye Exams. Frequent IOP checks help catch spikes early.
Home Monitoring. Use a hand-held tonometer if advised to track pressure between visits.
Smoking Cessation. Improves overall eye and surgical outcomes.
Hydration and Diet. Balanced fluid intake and a nutrient-rich diet support vascular health.
Antioxidant-Rich Foods. Leafy greens and colorful fruits may protect optic nerve cells NCBIEyeWiki.
When to See a Doctor
Seek immediate ophthalmology care if you experience sudden vision changes, colored halos around lights, persistent eye redness, or severe headache with eye pain. An IOP above 30 mmHg that does not respond quickly to initial drops constitutes an emergency to prevent optic nerve damage EyeWikiNCBI.
Dietary Guidance
What to Eat
Leafy Greens (spinach, kale) for lutein and zeaxanthin.
Cold-Water Fish (salmon, sardines) rich in omega-3 fatty acids.
Colorful Fruits (citrus, berries) high in vitamin C and antioxidants.
Whole Grains for stable blood sugar and vascular health.
Plenty of Water to maintain healthy eye fluid dynamics PreventionPMC.
What to Avoid
Excessive Caffeine, which may transiently raise IOP.
Heavy Alcohol Use, causing dehydration and pressure shifts.
High-Salt Foods, linked to fluid retention and blood pressure spikes.
Processed Trans Fats, which harm vascular health.
Sugary Drinks and Snacks, contributing to metabolic stress Glaucoma Research Society of CanadaFrontiers.
Frequently Asked Questions
1. What triggers Posner–Schlossman syndrome?
The exact trigger is unknown, but immune dysregulation and infections like CMV are leading theories EyeWikiNCBI.
2. Who is most at risk?
Adults aged 20–50, often males, are more frequently affected, though anyone can develop PSS EyeWikiNCBI.
3. How often do attacks recur?
Frequency varies—from monthly to once every few years—and tends to recur in the same eye WikipediaPMC.
4. Is PSS painful?
Discomfort is usually mild; pain is out of proportion to the high pressure seen on measurement WikipediaPMC.
5. Can PSS lead to permanent vision loss?
Yes—if repeated pressure spikes damage the optic nerve, secondary glaucoma can occur NCBIWikipedia.
6. How is PSS diagnosed?
Diagnosis is clinical, based on slit-lamp exam, IOP measurement, and ruling out other uveitic or glaucomatous causes NCBIWikipedia.
7. Are there blood tests for PSS?
Blood tests may identify viral antibodies (e.g., CMV) but are not definitive; aqueous fluid analysis is more accurate NCBIWikipedia.
8. How long does an attack last?
Attacks last from a few hours up to several weeks and resolve with treatment WikipediaPMC.
9. Can both eyes be affected?
Bilateral simultaneous attacks are very rare; PSS is almost always unilateral WikipediaPMC.
10. Is PSS the same as primary open-angle glaucoma?
No—PSS has mild inflammation with pressure spikes, while open-angle glaucoma is a chronic pressure increase without inflammation NCBIWikipedia.
11. Can antiviral drugs cure PSS?
Antivirals can control CMV-associated attacks but do not cure the underlying syndrome NCBIWikipedia.
12. When is surgery needed?
Surgery is reserved for cases unresponsive to maximal medical therapy or when optic nerve damage progresses EyeWikiWikipedia.
13. How often should I have eye exams?
During active phases, exams may be monthly; in remission, every 3–6 months is typical NCBIWikipedia.
14. Can PSS occur in children?
It is extremely rare in children but has been reported in isolated cases WikipediaPMC.
15. Is there ongoing research?
Yes—studies on antiviral prophylaxis, immunomodulatory biologics, and regenerative cell therapies are underway NCBIWikipedia.
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Last Updated: August 04, 2025.
