Clinical Profile and Etiological Spectrum of Secondary Glaucoma at a Tertiary Eye Care Centre in Karnataka, South India: A Retrospective Observational Study

Abstract

Objective: To describe the demographic characteristics, etiological spectrum, and clinical presentation profile of secondary glaucoma among patients presenting to a tertiary eye care centre in Karnataka, South India, including comparisons between pediatric and adult subgroups, while distinguishing patient-level from eye-level parameters.

Material and Methods: This retrospective, single-centre, observational study included 300 patients (365 eyes) with a clinical diagnosis of secondary glaucoma presenting to a tertiary eye care hospital in Bangalore, Karnataka, between March 2025 and April 2026. Data were abstracted from medical records and analyzed separately at the patient level (demographic and systemic comorbidity variables) and the eye level (etiology, visual acuity, intraocular pressure [IOP], anterior segment, gonioscopic, and fundus variables) to avoid unit-of-analysis errors arising from inter-eye correlation in bilaterally affected patients.

Results: The mean age of the cohort was 48.6 ± 21.4 years; 170 patients (56.7%) were male, and 34 (11.3%) were younger than 18 years. Bilateral involvement was present in 65 patients (21.7%). Lens-induced glaucoma was the most frequent aetiology (63 eyes, 17.3%), followed by inflammatory/uveitic glaucoma (58, 15.9%), neovascular glaucoma (53, 14.5%), and steroid-induced glaucoma (44, 12.1%). Presenting best-corrected visual acuity was worse than 6/60 in 149 eyes (40.8%), and mean presenting IOP was 27.4 ± 11.8 mmHg. Severe visual impairment, elevated IOP, and advanced optic nerve cupping were concentrated predominantly in the neovascular and lens-induced subgroups. The pediatric subgroup (n = 34) differed significantly from adults in aetiology (predominantly developmental anterior-segment anomalies), bilaterality (35.3% vs. 19.9%; p = 0.044), and systemic comorbidity burden (82.4% vs. 43.2% with no comorbidity; p < 0.001).

Conclusions: Lens-induced and neovascular glaucoma were the leading and most visually damaging categories of secondary glaucoma at this South Indian tertiary centre, while pediatric secondary glaucoma showed a distinct, largely developmental aetiological pattern. These findings identify lens-induced and neovascular glaucoma as priority targets for earlier detection and referral in this population.