Monday Night Chat Highlights
September 17, 2001

Norma Devine, Editor

On Monday, September 17, 2001, Dr. Jeff Henderer, a glaucoma specialist at Wills, paid a visit to the Monday night chat room. 

Dr. Jeff Henderer:  Hello, everyone.  Sorry to be away so long, but that's the way it's been lately.

Monitor:  We're glad you can join us now.

Dr. Jeff Henderer:  I understand there is a question?

P:  Yes.  Have you ever heard of  ICE (iridocorneal endothelial) syndrome?  

Dr. Jeff Henderer:  Yes. 

P:  Can it be misinterpreted as having symptoms similar to glaucoma?

Dr. Jeff Henderer:  Well, that is an interesting twist.  Since this type of glaucoma is quite uncommon, I would say that it is often misinterpreted as having some other cause.  

P:  My glaucoma specialist  has conferred with another local glaucoma specialist.  Both now agree on the diagnosis of ICE syndrome.  It seems that I have had corneal edema since my surgery last month, on August 28th.

Dr. Jeff Henderer:  The features of ICE syndrome are interesting.  There are three.  The first is essential iris atrophy.  It is the most common.  Then there is the iris nevus syndrome.  The third, and most uncommon, is Chandler's syndrome.  Generally, these are unilateral causes of glaucoma.  Other congenital conditions can mimic ICE syndrome, but they are almost always bilateral, while ICE is almost always unilateral. 

P:  What causes ICE syndrome?  

Dr. Jeff Henderer:  The cause is unknown, but is thought, perhaps, to be due to herpes.  The problem is that the corneal endothelium (which lines the inside of the cornea) grows outward and over the trabecular meshwork.  The problem then is that the meshwork is blocked and the pressure goes up.  The cells also grow over the iris surface, which causes the strange pupillary findings and other things.

P:  Could rubella before birth be a factor?

Dr. Jeff Henderer:  I don't know about rubella and ICE syndrome, but it does cause glaucoma in kids.

P:  Right now my vision is blurred.  Is that caused by the cornea or the iris?

Dr. Jeff Henderer:  The iris shouldn't cause blurred vision, even with very odd pupillary appearances.  More likely it is the cornea. That is the feature that distinguishes Chandler's syndrome from the others, but all three that I mentioned earlier are sort of a spectrum of the disease.  

P:  Which specialist is best able to treat ICE?

Dr. Jeff Henderer:  A glaucoma specialist, as the main problem is glaucoma.  The treatment of ICE syndrome is tough. 

Medications may help.  Laser does not.  Various surgeries have been tried with mixed results.

P:  My doctor just started me on Pred Forte and Cosopt tonight.  Will I eventually have my normal focal vision restored?   

Dr. Jeff Henderer:  If the IOP (intraocular pressure) can be normalized and your cornea remains clear, you may have the potential to see well.  

P:  How often does this type of glaucoma occur?

Dr. Jeff Henderer:  This is a rare cause of glaucoma. I don't know a number off the top of my head.  I have only seen a couple cases, and none of them were Chandler's.

P:  My doctor says it is rare.

Dr. Jeff Henderer:  Yes, it is.  But of the three types (essential iris atrophy, iris nevus syndrome, and Chandler's syndrome), do you know which one you have?

P:  My doctor did not specify any one of the three.

Dr. Jeff Henderer:  It makes no difference in treatment that I'm aware of.  It just might be interesting to know.  

P:  Are these conditions manifested in any way before a supposed diagnosis of glaucoma? 

Dr. Jeff Henderer:  Sure.  All three cause changes in the front of the eye.  Some are more dramatic than others.  In the order of causing odd changes, there are:  (1) essential iris atrophy, (2) iris nevus, and (3) Chandler's, which can be very subtle.  The most common feature is a very irregular pupil shape and even multiple pupils (essential iris atrophy), little brown bumps on the iris (iris nevus) and almost normal (Chandler's).

P:  Is it possible to have ICE syndrome, but not have glaucoma?

Dr. Jeff Henderer:  The ICE syndrome causes the glaucoma.  It is possible to have an ICE syndrome and not have glaucoma, but it is likely only a matter of time.

P:  My IOP after the trabeculectomy was 14 mm Hg; now it's up to 31 mm Hg.  As I understand it, my cornea is blocking the flow of fluid, causing the rise in IOP, leading to glaucoma.  Is that right?  

Dr. Jeff Henderer:  Correct. This is a disease of your cornea, believe it or not, and it is causing a glaucoma.  One other endothelial disease can do this, too:  posterior polymorphous dystrophy, which is a bilateral, inherited cornea dystrophy.

P:  Why did this happen after the trabeculectomy?

Dr. Jeff Henderer:  The problem with surgery is that the membrane grows over the trab site and causes it to fail.  Some have success with repeat trabs, but others advocate tubes, although these are not fail-proof either.

Monitor:  This is an unusual discussion.  

Dr. Jeff Henderer:  Well, this is a great discussion (at least for me).  Am I way over people's heads?  I hope I made sense.  

Monitor:  You did, indeed.  I hope we can use the information you provided in a chat highlight.  

P:  Is it not common for the area around the trabeculectomy to close over, after a length of time?

Dr. Jeff Henderer:  It is common for a trab to fail over time.  More common than we'd like, anyway.

P:  I guess "being a good healer" is not good for trabeculectomies. 

Dr. Jeff Henderer:  Well, that is a good point.  But ICE syndrome is an odd form of glaucoma that is rare even for specialists to see,  and it is not commonly discussed.   I just  wanted to make sure that you understood what I have been saying and to make sure you are not confused.   

P:  Thank you.  I understand everything you said very well.  My doctor is opting for an aggressive tactic using Cosopt and Pred Forte to lower the pressure.  It's beginning to look like another trab will not work.  

Dr. Jeff Henderer:  I agree with the treatment.  If you need further IOP lowering, more surgery might be needed in the future.  It often is in eyes like this.

P:  You are really great to come and talk to us.  We would all have questions, but we like to wait our turn, and let those with the most urgent need get their questions answered first.    

Dr. Jeff Henderer:  I now operate every other Monday night, so I will be limited in my visits, but I'll be here when I can.  I enjoy talking to you all!

Monitor:  We are grateful for any minutes you can spare.  

Dr. Jeff Henderer:  Good night all!

End of highlights for September 17, 2001.

On September 19, Dr. Wilson discussed "Measuring Your Own Eye Pressure" in the Chat room. Click here for highlights of that meeting.

Click here for the most recent glaucoma chat highlights and links to the chat archives.

Click here for upcoming glaucoma chat events.