Ghost cell glaucoma (GCG) is a type of secondary

glaucoma Glaucoma is a group of eye diseases that result in damage to the optic nerve (or retina) and cause vision loss. The most common type is open-angle (wide angle, chronic simple) glaucoma, in which the drainage angle for fluid within the eye rem ...

occurs due to long standing

vitreous hemorrhage Vitreous hemorrhage is the extravasation, or leakage, of blood into the areas in and around the vitreous humor of the eye. The vitreous humor is the clear gel that fills the space between the lens and the retina of the eye. A variety of conditio ...

. The rigid and less pliable degenerated red blood cells (ghost cells) block the

trabecular meshwork The trabecular meshwork is an area of tissue in the eye located around the base of the cornea, near the ciliary body, and is responsible for draining the aqueous humor from the eye via the anterior chamber (the chamber on the front of the ...

and increase the pressure inside eyes.

Pathophysiology

The ghost cells develop within the vitreous cavity, 1–3 weeks after vitreous hemorrhage. They obstruct the trabecular meshwork and eventually the pressure inside eye (

intraocular pressure Intraocular pressure (IOP) is the fluid pressure inside the eye. Tonometry is the method eye care professionals use to determine this. IOP is an important aspect in the evaluation of patients at risk of glaucoma. Most tonometers are calibrated t ...

) increases and leads to glaucoma. A variety of ocular conditions may cause GCG. Main causes include ocular

trauma Trauma most often refers to: * Major trauma, in physical medicine, severe physical injury caused by an external source * Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic i ...

diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...

sickle cell disease Sickle cell disease (SCD) is a group of blood disorders typically inherited from a person's parents. The most common type is known as sickle cell anaemia. It results in an abnormality in the oxygen-carrying protein haemoglobin found in red b ...

uveitis Uveitis () is inflammation of the uvea, the pigmented layer of the eye between the inner retina and the outer fibrous layer composed of the sclera and cornea. The uvea consists of the middle layer of pigmented vascular structures of the eye and in ...

, UGH syndrome, many eye surgeries etc.

Signs and symptoms

Myriad small cells may be seen in the

aqueous humor The aqueous humour is a transparent water-like fluid similar to plasma, but containing low protein concentrations. It is secreted from the ciliary body, a structure supporting the lens of the eyeball. It fills both the anterior and the posteri ...

during

slit lamp A slit lamp is an instrument consisting of a high-intensity light source that can be focused to shine a thin sheet of light into the eye. It is used in conjunction with a biomicroscope. The lamp facilitates an examination of the anterior segme ...

examination. Intraocular pressure rises up to 30 to 70 mm Hg. The increased intraocular pressure may cause blurring of vision, headache, brow ache,

nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the ...

and/or

vomiting Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteri ...

. The angle of anterior chamber is seen open with

gonioscopy Gonioscopy a routine ophthalmological procedure that measures the angle between the iris and the cornea (the iridocorneal angle), using a goniolens (also known as a gonioscope) together with a slit lamp or operating microscope. Its use is import ...

Complications

If the increased intraocular pressure is uncontrolled, it may lead to

optic nerve In neuroanatomy, the optic nerve, also known as the second cranial nerve, cranial nerve II, or simply CN II, is a paired cranial nerve that transmits visual information from the retina to the brain. In humans, the optic nerve is derived fro ...

damage and irreversible

visual impairment Visual impairment, also known as vision impairment, is a medical definition primarily measured based on an individual's better eye visual acuity; in the absence of treatment such as correctable eyewear, assistive devices, and medical treatment� ...

Treatment

The condition usually resolves once the vitreous hemorrhage has cleared. But, depending on the seriousness of the increased intraocular pressure, medical or surgical treatment may be advised. If IOP is not so high, medical therapy with aqueous suppressants is preferred. Surgery is advised if the intraocular pressure remains in 40- to 50-mm Hg range even after medical therapy. Anterior chamber can be cleaned by making a small paracentesis in the

cornea The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber. Along with the anterior chamber and lens, the cornea refracts light, accounting for approximately two-thirds of the eye's total optical ...

and irrigating the

anterior chamber The anterior chamber ( AC) is the aqueous humor-filled space inside the eye between the iris and the cornea's innermost surface, the endothelium. Hyphema, anterior uveitis and glaucoma are three main pathologies in this area. In hyphema, blood f ...

with a

saline solution Saline (also known as saline solution) is a mixture of sodium chloride (salt) and water. It has a number of uses in medicine including cleaning wounds, removal and storage of contact lenses, and help with dry eyes. By injection into a vein i ...

. Repeat evacuation and aspiration are required if myriad cells accumulate again in anterior chamber.

History

Campbell et al. described Ghost cell glaucoma in 1976. Campbell and Grant described the condition and given the name ghost cell glaucoma. Fenton and Zimmerman called it hemolytic glaucoma.

References

{{reflist Glaucoma