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Pupillary Block, Aphakic: Differential Diagnoses & Workup

Author: Deborah R Eezzuduemhoi, MD, Assistant Professor, Department of Ophthalmology and Visual Sciences, Texas Tech University, Health Sciences Center School of Medicine
Coauthor(s): Deborah Wilson, MD, Director of Glaucoma Service, Assistant Professor, Department of Ophthalmology, Georgetown University Medical Center
Contributor Information and Disclosures

Updated: Jul 23, 2008

Differential Diagnoses

Choroidal Detachment
Glaucoma, Malignant

Other Problems to Be Considered

  • Malignant or ciliary block glaucoma
    • Malignant or ciliary block glaucoma results from any cause of anterior chamber shallowing that may lead to forward displacement of the iris diaphragm and rotation of the ciliary body and subsequent misdirection of the aqueous humor toward the vitreous.
    • It is a rare complication of cataract extraction with or without intraocular lens implantation, trabeculectomy, and glaucoma triple procedure (trabeculectomy combined with extracapsular cataract extraction and posterior chamber intraocular lens implantation).
    • Hypotony due to loose suturing of the corneoscleral wound or hyperfiltration of a trabeculectomy may lead to a vicious cycle of anterior chamber shallowing, forward displacement of the iris-capsule diaphragm, and aqueous misdirection and further anterior chamber shallowing.
    • When cycloplegics are stopped early in the postoperative period, malignant or ciliary block glaucoma may occur.
    • The absence of a functioning iridectomy predisposing to relative pupillary block may be one of the initial phases in the spectrum of aqueous misdirection.
  • Suprachoroidal hemorrhage
    • Suprachoroidal hemorrhage is characterized by a sudden onset of excruciating pain, increased intraocular pressure, and a shallow or flat anterior chamber.
    • Dark nonserous choroidal detachment can be seen on funduscopic examination or on B-scan ultrasound.
  • Choroidal separation
    • A very shallow or flat anterior chamber in aphakia also is seen in choroidal separation (choroidal detachment).
    • The distinguishing feature is a subnormal IOP in the case of choroidal separation, while this is normal or elevated in pupillary block.

Workup

Other Tests

  • Gonioscopy
  • Tonometry
  • Evaluation of the optic nerve head
  • Visual field testing

Procedures

More on Pupillary Block, Aphakic

Overview: Pupillary Block, Aphakic
Differential Diagnoses & Workup: Pupillary Block, Aphakic
Treatment & Medication: Pupillary Block, Aphakic
Follow-up: Pupillary Block, Aphakic
References
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References

  1. Kumar A, Kedar S, Garodia VK. Angle closure glaucoma following pupillary block in an aphakic perfluoropropane gas-filled eye. Indian J Ophthalmol. Sep 2002;50(3):220-1. [Medline].

  2. Shaffer RN. The role of vitreous detachment in aphakic and malignant glaucoma. Trans Am Acad Ophthalmol Otolaryngol. 1954;58:217-231.

  3. Posner A. Postcataract glaucoma associated with shallow anterior chamber. Int Ophthalmol Clin. 1964;4:1029-1043.

  4. Beekhuis WH, Ando F, Zivojnovic R, et al. Basal iridectomy at 6 o'clock in the aphakic eye treated with silicone oil: prevention of keratopathy and secondary glaucoma. Br J Ophthalmol. Mar 1987;71(3):197-200. [Medline].

  5. Chandler PA. Glaucoma from pupillary block in aphakia. Arch Ophthalmol. 1962;7:44-47.

  6. Chandler PA, Simmons RJ. Gonioscopy during surgery for aphakic eyes with pupillary block. Am J Ophthalmol. Oct 1972;74(4):571-80. [Medline].

  7. Cotlier E. Aphakic flat anterior chamber. IV. Treatment of pupillary block by iridectomy. Arch Ophthalmol. Jul 1972;88(1):22-6. [Medline].

  8. Jaffe NS, Light DS. The danger of air pupillary block glaucoma in cataract surgery with osmotic hypotonia. Arch Ophthalmol. Nov 1966;76(5):633-4. [Medline].

  9. Koc F, Kargi S, Biglan AW, et al. The aetiology in paediatric aphakic glaucoma. Eye. Dec 2006;20(12):1360-5. [Medline].

  10. Mandal AK, Bagga H, Nutheti R. Trabeculectomy with or without mitomycin-C for paediatric glaucoma in aphakia and pseudophakia following congenital cataract surgery. Eye. Jan 2003;17(1):53-62. [Medline].

  11. Tomey KF, Traverso CE. Neodymium-YAG laser posterior capsulotomy for the treatment of aphakic and pseudophakic pupillary block. Am J Ophthalmol. Nov 15 1987;104(5):502-7. [Medline].

  12. Tomey KF, Traverso CE. The glaucomas in aphakia and pseudophakia. Surv Ophthalmol. Sep-Oct 1991;36(2):79-112. [Medline].

  13. Zborowski-Gutman L, Treister G, Naveh N, et al. Acute glaucoma following vitrectomy and silicone oil injection. Br J Ophthalmol. Dec 1987;71(12):903-6. [Medline].

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Further Reading

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Keywords

pupillary block, aphakic pupillary block, aphakia, pupillary block glaucoma, angle closure, cataract surgery, cataracts, cataract extraction, crystalline lens, lens implantation, lens subluxation, anterior pupillary block, posterior pupillary block, intraocular trauma

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Contributor Information and Disclosures

Author

Deborah R Eezzuduemhoi, MD, Assistant Professor, Department of Ophthalmology and Visual Sciences, Texas Tech University, Health Sciences Center School of Medicine
Deborah R Eezzuduemhoi, MD is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, and Women in Ophthalmology, Inc
Disclosure: Nothing to disclose.

Coauthor(s)

Deborah Wilson, MD, Director of Glaucoma Service, Assistant Professor, Department of Ophthalmology, Georgetown University Medical Center
Deborah Wilson, MD is a member of the following medical societies: American Academy of Ophthalmology and American College of Physicians
Disclosure: Nothing to disclose.

Medical Editor

Neil T Choplin, MD, Adjunct Clinical Professor, Department of Surgery, Section of Ophthalmology, Uniformed Services University of Health Sciences
Neil T Choplin, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, Association for Research in Vision and Ophthalmology, and California Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

J James Rowsey, MD, Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida
J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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