University of Iowa Health Care

Ophthalmology and Visual Sciences

Iowa Glaucoma Curriculum

Supplementary Material


Chapter 32

Cases from
Cogan-Reese Syndrome: A Rare Case of Unilateral Glaucoma: 69-year-old woman presented to the University of Iowa Hospitals and Clinics (UIHC) glaucoma clinic for evaluation of decreased vision in the left eye (OS) in the setting of elevated intraocular pressure (IOP) OS.

Iridocorneal Endothelial Syndrome (ICE) - essential iris atrophy: 63-year-old female with PAS, "iris mass", corectopia, and increased IOP OS.


ICE cases from

ICE Syndrome - Subtle: This is a 43 year-old with unilateral glaucoma with an intraocular pressure to 15 mmHg and a history of a failed trabeculectomy. A great example of the endothelial changes on slit lamp examination.
Courtesy of Young H. Kwon, M.D., Ph.D., The University of Iowa

Iridocorneal Endothelial: 61 year-old woman with unilateral ICE. Her slit lamp exam shows the hammered silver endothelium characteristic of ICE.
Courtesy of Young H. Kwon, M.D., Ph.D., The University of Iowa

Presumed Early ICE: This is a 62 year-old woman whose physician noticed an iridocorneal adhesion one month prior to this exam. The same physician had followed this patient earlier and had never noticed a similar change. The patient’s intraocular pressure was 16 mmHg in both eyes. The central corneal endothelium was normal in this eye but the diagnosis by both the corneal specialist and glaucoma specialist was that this is probably a very early variant of ICE with abnormalities only in the peripheral cornea.

Early ICE: This 57 year-old man had been noted to have an elevated intraocular pressure in his right eye only since 2000. In 2006 he was noted to have an intraocular pressure of 34 mmHg in the right eye. On examination he has 20/40 vision in the right eye and 20/20 vision in the left eye. His intraocular pressure on three medications is 12 mmHg OD and 8 mmHg OS. The right eye has corectopia and iris nodules. He has mild corneal edema and the hammered silver appearance to his corneal endothelium. He was diagnosed with Cogan-Reese variant of the iridocorneal endothelial syndrome.
Courtesy of Young H. Kwon, M.D., Ph.D., The University of Iowa

Essential Iris Atrophy - slit lamp only: This 38-year-old woman was diagnosed with glaucoma at age 36. She had been treated with multiple medications and had had an argon laser trabeculoplasty. When she was first seen here she 20/30 vision within an intraocular pressure of 34 mm Hg.
Courtesy of Young H. Kwon, M.D., Ph.D., The University of Iowa

Essential Iris Atrophy - 1: Iridocorneal-endothelium syndrome. This is the essential iris atrophy variant with extensive iris damage and synechial angle closure. This patient also has corneal edema.
Courtesy of Young H. Kwon, M.D., Ph.D., The University of Iowa

Essential Iris Atrophy - 2: At 41 this patient was diagnosed with glaucoma. In 1974 at the age of 42 she saw Frederick Blodi and was found to have areas of iris atrophy with a diagnosis of essential iris atrophy. Her intraocular pressure was 42 mmHg and she underwent a Scheie thermal sclerostomy in 1974 by Dr. Charles Phelps. In 2007 at the time when this video was made she had a functioning trabeculectomy with an intraocular pressure of 8 mmHg on no medications, 33 years after her Scheie procedure.

Iridocorneal Endothelial Cogan-Reese: This patient at the age of 69 awoke with sudden decreased vision in the left eye. She was found to have an intraocular pressure of 57 mmHg and was started on medical therapy with a poor response.

PDS OD, ICE OS: At 35 years old was diagnosed with both pigment dispersion OD and essential iris atrophy OS. Her essential iris atrophy prevented her development of PDS OS.