In markedly unilateral glaucoma, always rule out secondary causes before labelling the disease as primary
December 16, 2025

In markedly unilateral glaucoma, always rule out secondary causes before labelling the disease as primary

Primary open-angle glaucoma is generally bilateral, even if asymmetric. Therefore, a strongly unilateral presentation should raise suspicion for secondary mechanisms.1 Numerous entities, including pseudoexfoliation, post-traumatic angle recession, steroid exposure, uveitic disorders, drug-induced uveal effusion, ghost-cell glaucoma, lens-induced (phacolytic) glaucoma, or secondary to previous surgery, can selectively affect one eye and require targeted management.1-5 Unilateral glaucoma may also arise from elevated episcleral venous pressure, neovascularisation, uveal melanoma, or rare congenital or acquired angle anomalies as ectropion uveae or iridocorneal endothelial syndrome. 1-6-7 Identifying these causes could prevent unnecessary treatment of the fellow eye and ensures appropriate, often aetiology-specific intervention.


References

  1. European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition. Br J Ophthalmol. 2021 Jun;105(Suppl 1):1-169. doi: 10.1136/bjophthalmol-2021-egsguidelines. PMID: 34675001.
  2. Schlötzer-Schrehardt U, Khor CC. Pseudoexfoliation syndrome and glaucoma: from genes to disease mechanisms. Curr Opin Ophthalmol. 2021 Mar 1;32(2):118-128. doi: 10.1097/ICU.0000000000000736. PMID: 33332884.
  3. Razeghinejad R, Lin MM, Lee D, Katz LJ, Myers JS. Pathophysiology and management of glaucoma and ocular hypertension related to trauma. Surv Ophthalmol. 2020 Sep-Oct;65(5):530-547. doi: 10.1016/j.survophthal.2020.02.003. Epub 2020 Feb 11. PMID: 32057763.
  4. Roberti G, Oddone F, Agnifili L, Katsanos A, Michelessi M, Mastropasqua L, Quaranta L, Riva I, Tanga L, Manni G. Steroid-induced glaucoma: Epidemiology, pathophysiology, and clinical management. Surv Ophthalmol. 2020 Jul-Aug;65(4):458-472. doi: 10.1016/j.survophthal.2020.01.002. Epub 2020 Feb 11. PMID: 32057761.
  5. Kesav N, Palestine AG, Kahook MY, Pantcheva MB. Current management of uveitis-associated ocular hypertension and glaucoma. Surv Ophthalmol. 2020 Jul-Aug;65(4):397-407. doi: 10.1016/j.survophthal.2019.12.003. Epub 2019 Dec 6. PMID: 31816329.
  6. Wen T, Wang L, Luo H, Tang L. Sturge-Weber syndrome secondary glaucoma: From Pathogenesis to Treatment. Eye Vis (Lond). 2025 Apr 17;12(1):16. doi: 10.1186/s40662-025-00432-6. PMID: 40241121; PMCID: PMC12004580.
  7. Silva L, Najafi A, Suwan Y, Teekhasaenee C, Ritch R. The iridocorneal endothelial syndrome. Surv Ophthalmol. 2018 Sep-Oct;63(5):665-676. doi: 10.1016/j.survophthal.2018.01.001. Epub 2018 Jan 11. PMID: 29331589.


Contributor: Jan Van Eijgen, MD PhD, FEBO Research Group of Ophthalmology (RGO), Department of Neurosciences, KU Leuven, Leuven, Belgium Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium

Example Image


Tip of the Month Manager: Karin Øyo-Szerenyi
Tip of the Month Editors: Karl Mercieca, Francisco Goñi
Tip of the Month Editors in Chief: Manuele Michelessi, Francesco Oddone