Ophthalmology spot diagnosis : Rubeosis Iridis


Definition: Neovascularization of iris

Pathophysiology: Causes that lead to retinal hypoxia triggers release of vasoproliferative factors include vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF) and others

rubeosis iridis neovascular glaucoma


1. Diabetic Retinopathy

2. Retinal Vascular Occlusive Diseases

  • Central Retinal Vein Occlusion (CRVO)
  • Ischaemic Hemiretinal Vein Occlusion

3. Ocular Ischaemic Syndrome

  • Carotid Artery Occlusive Disease
  • Takayasu’s Syndrome
  • Carotid-Cavernous Fistula
  • Giant Cell Arteritis
  • Wyburn-Mason syndrome
  • Strabismus Surgery
  • Ocular Radiation

4. Tumours

  • Uveal Melanomas
  • Metastatic Choroidal Tumours
  • Medulloepithelioma
  • Hypoxic Retinoblastoma
  • Pigmented Ciliary Adenocarcinoma
  • Metastatic Malignant Lymphoma

5. Others

  • Uveitis
  • Retinal Vasculitis
  • Coat’s Disease (Retinal telangiectasia)
  • Eales’ Disease (Periphlebitis retinae)
  • Sarcoidosis
  • X-linked Retinoschisis
  • Chronic Retinal Detachment
  • Retinopathy of Prematurity (ROP)
  • Systemic Cryoglobulinaemia

Important causes:

  1. Proliferative Diabetic Retinopathy (PDR)
  2. Central Retinal Vein Occlusion (CRVO)
  3. Sickle cell retinopathy
  4. Chronic iridocyclitis
  5. Retinoblastoma

Grading of rubeosis iridis:

  • 0 : No iris neovascularization
  • 1 : Less than 2 quadrants of NV at iris pupillary zone
  • 2 : More than 2 quadrants of NV at iris pupillary zone
  • 3 : Grade 2 + less than 3 quadrants of NV at iris ciliary zone and/or ectropion uveae
  • 4 : More than 3 quadrants of NV at iris ciliary zone and/or ectropion uveae


  1. Abnormal iris vessels
  2. Perform gonioscopy to assess presence of angle neovascularization
  3. May have elevated IOP (neovascular glaucoma)

Rubeosis Iridis and Neovascular glaucoma:

The disease develops in 3 stages:

1. Neovascularization of the iris (NVI)

2. Secondary open angle glaucoma (SOAG): The NVI extend to involve the angle, and are accompanied by fibrosis, blocking the trabecular meshwork and  causing ocular hypertension, and SOAG.

3. Secondary angle closure glaucoma (SACG): Myofibroblasts within the fibrovascular tissue proliferate and contract, forming peripheral anterior synechiae (PAS), and secondary angle closure, with resulting intra-ocular pressure rise.

100 days glaucoma: Neovascular glaucoma (NVG) secondary to ischemic CRVO


  1. Ischemia: Panretinal Photocoagulation (PRP)
  2. IOP control: Glaucoma drainage implant (e.g. Molteno’s tube)

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