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Aphakic Pupillary Block Differential Diagnoses

  • Author: Mitchell V Gossman, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: May 02, 2014
 
 

Diagnostic Considerations

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.

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Mitchell V Gossman, MD Partner and Vice President, Eye Surgeons and Physicians, PA; Medical Director, Central Minnesota Surgical Center; Clinical Associate Professor, University of Minnesota Medical School

Mitchell V Gossman, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, Minnesota Medical Association, North American Neuro-Ophthalmology Society, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

J James Rowsey, MD Former Director of Corneal Services, St Luke's Cataract and Laser Institute

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, Sigma Xi, Southern Medical Association, Pan-American Association of Ophthalmology

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

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, Association for Research in Vision and Ophthalmology, American Glaucoma Society, California Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

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.

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.

References
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  9. Koc F, Kargi S, Biglan AW, et al. The aetiology in paediatric aphakic glaucoma. Eye. 2006 Dec. 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. 2003 Jan. 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. 1987 Nov 15. 104(5):502-7. [Medline].

  12. Tomey KF, Traverso CE. The glaucomas in aphakia and pseudophakia. Surv Ophthalmol. 1991 Sep-Oct. 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. 1987 Dec. 71(12):903-6. [Medline].

 
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