Glaucoma

Angle Recession

Gonioscopic examination of a traumatic angle recession shows widening of the ciliary body band.
  • Separation between the longitudinal and circular muscle of the ciliary body (commonly caused by blunt injury to the eye)
  • Incidence of intraocular pressure elevation appears to be directly related to the extent of angle involvement (may require at least 180 or 270 degree involvement)

Clinical Features

  • Symptoms:
    • May be asymptomatic
    • In the acute phase following injury, early onset glaucoma may be related to concurrent uveitis or hyphema
  • Signs:
    • Intraocular pressure may remain normal for years or decades before becoming elevated
    • Associated findings may include corneal edema, pupillary sphincter tear, subluxated lens, or hyphema
    • Gonioscopic examination may demonstrate:
      • The classic finding of a widened ciliary body band
      • Posterior iris displacement
      • Baring of the ciliary processes

Management

  • Routine follow-up of patient with recessed angle but no IOP elevation
  • Topical steroid therapy may be used with early post-traumatic IOP elevation believed secondary to increased outflow resistance from trabecular edema and inflammation
  • Anti-glaucoma medications such as aqueous suppressants (e.g. beta adrenergic antagonists), alpha2 adrenergic agonist, and miotics may be given
  • Surgical treatment (e.g. glaucoma filtration surgery) may be indicated for glaucoma unresponsive to medical therapy