Tip of the Month
Publishing date: July 2021
Angle recession (AR) is a common complication after a blunt ocular trauma, and it is related to a higher risk of developing late-onset glaucoma (1). The postulated mechanism of intraocular pressure (IOP) elevation is trabecular meshwork scarring from the traumatism in combination with an underlying predisposition for primary open-angle glaucoma (2).
Increased IOP and hypertensive response to steroids have been evidenced not only in the AR eye but also in the non-traumatized fellow eye (3). One study has even exposed that 50% of AR glaucoma patients develop glaucoma in the fellow eye (4). Interestingly, reduced dimensions of the Schlemm canal have been found in a small control study in AR glaucoma eyes, and interestingly, also in their fellow eyes (5). Therefore, a meticulous gonioscopy should be done in the early post-traumatic period to identify AR, and if glaucoma is diagnosed, the non-traumatized fellow eye should also be periodically checked.
Contributor: Nuria Mendieta, FEBO MD, Ophthalmology Department, Hospital de la Esperanza, Barcelona, Spain
1. Kaufman J, Tolpin D. Glaucoma after traumatic angle recession. Am J Ophthalmol 1974;78:648-654.
2. Hescher J. Trabecular damage due to blunt anterior segment injury and its relationship to traumatic glaucoma. Trans Sect Ophthalmol Otolaryngol 1977;83(2):239-248.
3. Spaeth GL. Traumatic hyphema, angle recession dexamethasone hypertension, and glaucoma. Arch Ophthalmol 1967;78(6):714-721.
4. Tesluk GC, Spaeth GL. The occurrence of primary open-angle glaucoma in the fellow eye of patients with unilateral angle-cleavage glaucoma. Ophthalmology 1985;92(7):904-911.
5. Mansoori T, Reddy AA, Balakrishna N. Identification and quantitative assessment of Schlemm’s canal in the eyes with 360º angle recession glaucoma. J Curr Glaucoma Pract 2020;14(1):25-29.
Tip of the Month manager: Frances Meier-Gibbons
Tip of the Month editorial board: Francisco Goni, Karl Mercieca, Humma Shahid
Tip of the Month editors in chief: Manuele Michelessi, Francesco Oddone