Glaucoma with inflammatory precipitates on the trabecular meshwork: A report of Grant's syndrome with ultrasound biomicroscopy of precipitates

Background: The syndrome of inflammatory precipitates on the trabecular meshwork is a rare form of inflammatory glaucoma that was described by Chandler and Grant in 1968 and subsequently given the eponym Grant's syndrome. Methods: We present two cases of elevated intraocular pressure associated with inflammatory precipitates on the trabecular meshwork in otherwise relatively quiet eyes, consistent with Grant's syndrome. We review the epidemiology, clinical features, and mechanism of this syndrome. In addition, we demonstrate the use of ultrasound biomicroscopy for imaging angle inflammatory precipitates. Results: Our patients demonstrate the cardinal features of Grant's syndrome, including acute onset, significant elevation of tension, trabecular meshwork precipitates in an otherwise quiet eye, limited response to typical pressure lowering agents, excellent response to topical steroids, evidence of recurrence with bilaterality, and systemic association with sarcoidosis. Ultrasound biomicroscopy proves to be a useful adjunct for pathologic imaging. Conclusions: The syndrome of glaucoma with inflammatory precipitates on the trabecular meshwork is a rare entity that should be considered as a possible diagnosis of elevated intraocular pressures in otherwise apparently quiet eyes.