Diagnostic Considerations

Ring melanoma of ciliary body^[40]

Elevated episcleral venous pressure/carotid cavernous fistula

Iridocorneal endothelial (ICE) syndrome

Uveitis-glaucoma-hyphema (UGH) syndrome

Angle recession refers to a tear between the circular and longitudinal fibers of the ciliary body. Cyclodialysis is defined as a detachment of the ciliary body from its insertion at the scleral spur. Iridodialysis is separation of the iris root from its attachment to the anterior ciliary body. By comparison, iridoschisis refers to splitting of layers of iris stroma. All of these conditions are sequelae of blunt ocular trauma, and any of these conditions may coexist. Laboratory studies have indicated that iridodialysis and cyclodialysis occur at higher blunt impact energies compared with the relatively lower thresholds resulting in angle recession.^[6]

Differential Diagnoses

Workup

Allingham RR, Damji KF, Freedman SF, Moroi SE, Rhee DJ, Shields MB, et al. Glaucomas associated with ocular trauma. Textbook of Glaucoma. 6th ed. Baltimore: Lippincott Williams & Williams; 2010.
Ng DS, Ching RH, Chan CW. Angle-recession glaucoma: long-term clinical outcomes over a 10-year period in traumatic microhyphema. Int Ophthalmol. 2014 Dec 18. [QxMD MEDLINE Link].
Bansal S, Gunasekeran DV, Ang B, Lee J, Khandelwal R, Sullivan P, et al. Controversies in the pathophysiology and management of hyphema. Surv Ophthalmol. 2016 May-Jun. 61 (3):297-308. [QxMD MEDLINE Link].
Wolff SM, Zimmerman LE. Chronic secondary glaucoma. Association with retrodisplacement of iris root and deepening of the anterior chamber angle secondary to contusion. Am J Ophthalmol. 1962. 84:547-63.
Sihota R, Sood NN, Agarwal HC. Traumatic glaucoma. Acta Ophthalmol Scand. 1995 Jun. 73(3):252-4. [QxMD MEDLINE Link].
Sponsel WE, Gray W, Scribbick FW, Stern AR, Weiss CE, Groth SL, et al. Blunt eye trauma: empirical histopathologic paintball impact thresholds in fresh mounted porcine eyes. Invest Ophthalmol Vis Sci. 2011 Jul. 52(8):5157-66. [QxMD MEDLINE Link].
Pujari A, Selvan H, Behera AK, Gagrani M, Kapoor S, Dada T. The Probable Mechanism of Traumatic Angle Recession and Cyclodialysis. J Glaucoma. 2020 Jan. 29 (1):67-70. [QxMD MEDLINE Link].
Sihota R, Kumar S, Gupta V, et al. Early predictors of traumatic glaucoma after closed globe injury: trabecular pigmentation, widened angle recess, and higher baseline intraocular pressure. Arch Ophthalmol. 2008 Jul. 126(7):921-6. [QxMD MEDLINE Link].
Girkin CA, McGwin G Jr, Long C, Morris R, Kuhn F. Glaucoma after ocular contusion: a cohort study of the United States Eye Injury Registry. J Glaucoma. 2005 Dec. 14(6):470-3. [QxMD MEDLINE Link].
Ozer PA, Yalvac IS, Satana B, Eksioglu U, Duman S. Incidence and risk factors in secondary glaucomas after blunt and penetrating ocular trauma. J Glaucoma. 2007 Dec. 16(8):685-90. [QxMD MEDLINE Link].
Mowatt L, Chambers C. Ocular morbidity of traumatic hyphema in a Jamaican hospital. Eur J Ophthalmol. 2010 May-Jun. 20(3):584-9. [QxMD MEDLINE Link].
Ng DS, Ching RH, Chan CW. Angle-recession glaucoma: long-term clinical outcomes over a 10-year period in traumatic microhyphema. Int Ophthalmol. 2015 Feb. 35 (1):107-13. [QxMD MEDLINE Link].
Glynn RJ, Seddon JM, Berlin BM. The incidence of eye injuries in New England adults. Arch Ophthalmol. 1988 Jun. 106(6):785-9. [QxMD MEDLINE Link].
Strahlman E, Elman M, Daub E, Baker S. Causes of pediatric eye injuries. A population-based study. Arch Ophthalmol. 1990 Apr. 108(4):603-6. [QxMD MEDLINE Link].
Chorich LJ 3rd, Davidorf FH, Chambers RB, Weber PA. Bungee cord-associated ocular injuries. Am J Ophthalmol. 1998 Feb. 125(2):270-2. [QxMD MEDLINE Link].
Endo S, Ishida N, Yamaguchi T. Tear in the trabecular meshwork caused by an airsoft gun. Am J Ophthalmol. 2001 May. 131(5):656-7. [QxMD MEDLINE Link].
Fineman MS, Fischer DH, Jeffers JB, Buerger DG, Repke C. Changing trends in paintball sport-related ocular injuries. Arch Ophthalmol. 2000 Jan. 118(1):60-4. [QxMD MEDLINE Link].
Roller RA, Almond NB, Anderson W. Traumatic iridodialysis in a student naval aviator applicant. Aviat Space Environ Med. 2005 Feb. 76(2):147-50. [QxMD MEDLINE Link].
Morris DS. Ocular blunt trauma: loss of sight from an ice hockey injury. Br J Sports Med. 2006 Mar. 40(3):e5; discussion e5. [QxMD MEDLINE Link]. [Full Text].
Capao Filipe JA, Fernandes VL, Barros H, Falcao-Reis F, Castro-Correia J. Soccer-related ocular injuries. Arch Ophthalmol. 2003 May. 121(5):687-94. [QxMD MEDLINE Link].
Vize CJ, Gauba V, Atkinson PL. Eye injury as a result of coat toggle trauma. Eye. 2007 Jan. 21(1):94-5. [QxMD MEDLINE Link].
Giovinazzo VJ, Yannuzzi LA, Sorenson JA, Delrowe DJ, Cambell EA. The ocular complications of boxing. Ophthalmology. 1987 Jun. 94(6):587-96. [QxMD MEDLINE Link].
Razeghinejad R, Lin MM, Lee D, Katz LJ, Myers JS. Pathophysiology and management of glaucoma and ocular hypertension related to trauma. Surv Ophthalmol. 2020 Sep - Oct. 65 (5):530-547. [QxMD MEDLINE Link].
McCarty CA, Fu CL, Taylor HR. Epidemiology of ocular trauma in Australia. Ophthalmology. 1999 Sep. 106(9):1847-52. [QxMD MEDLINE Link].
Nwosu SN. Domestic ocular and adnexal injuries in Nigerians. West Afr J Med. 1995 Jul-Sep. 14(3):137-40. [QxMD MEDLINE Link].
Koval R, Teller J, Belkin M, Romem M, Yanko L, Savir H. The Israeli Ocular Injuries Study. A nationwide collaborative study. Arch Ophthalmol. 1988 Jun. 106(6):776-80. [QxMD MEDLINE Link].
Desai P, MacEwen CJ, Baines P, Minassian DC. Epidemiology and implications of ocular trauma admitted to hospital in Scotland. J Epidemiol Community Health. 1996 Aug. 50(4):436-41. [QxMD MEDLINE Link].
Salmon JF, Mermoud A, Ivey A, Swanevelder SA, Hoffman M. The detection of post-traumatic angle recession by gonioscopy in a population-based glaucoma survey. Ophthalmology. 1994 Nov. 101(11):1844-50. [QxMD MEDLINE Link].
Poon A, McCluskey PJ, Hill DA. Eye injuries in patients with major trauma. J Trauma. 1999 Mar. 46(3):494-9. [QxMD MEDLINE Link].
Malik AH, Shah AA, Ahmad I, Shah BA. Ocular Injuries in Patients of Zygomatico-Complex (ZMC) Fractures. J Maxillofac Oral Surg. 2017 Jun. 16 (2):243-247. [QxMD MEDLINE Link].
Desai P, MacEwen CJ, Baines P, Minassian DC. Incidence of cases of ocular trauma admitted to hospital and incidence of blinding outcome. Br J Ophthalmol. 1996 Jul. 80(7):592-6. [QxMD MEDLINE Link].
Wilson MR, Wooten F, Williams J. Frequency and characteristics of ocular trauma in an urban population. J Natl Med Assoc. 1991 Aug. 83 (8):697-702. [QxMD MEDLINE Link].
Mahapatra SK, Malhotra K, Mendke RG. A 3-year prospective study on ocular injuries with tennis or cricket ball while playing cricket: A case series. Indian J Ophthalmol. 2018 Feb. 66 (2):256-261. [QxMD MEDLINE Link].
Kalamkar C, Mukherjee A. Incidence, clinical profile, and short-term outcomes of post-traumatic glaucoma in pediatric eyes. Indian J Ophthalmol. 2019 Apr. 67 (4):509-514. [QxMD MEDLINE Link].
Melamed S, Ashkenazi I, Gutman I, Blumenthal M. Nd:YAG laser trabeculopuncture in angle-recession glaucoma. Ophthalmic Surg. 1992 Jan. 23(1):31-5. [QxMD MEDLINE Link].
Kashiwagi K, Tateno Y, Kashiwagi F, Tsukahara S. Changes in Anterior Chamber Depth due to Contusion. Ophthalmic Res. 2009 Aug 7. 42(4):193-198. [QxMD MEDLINE Link].
Ozdal MP, Mansour M, Deschênes J. Ultrasound biomicroscopic evaluation of the traumatized eyes. Eye. 2003 May. 17(4):467-72. [QxMD MEDLINE Link].
Liu RJ, Wang M, Xia WT, Yu XY, Chen JM, Zhou S, et al. [Comparison of anterior chamber angle examination by UBM, SL-OCT and gonioscopy]. Fa Yi Xue Za Zhi. 2014 Aug. 30 (4):261-3. [QxMD MEDLINE Link].
Rumelt S, Bersudsky V, Blum-Hareuveni T, Rehany U. Preexisting and postoperative glaucoma in repeated corneal transplantation. Cornea. 2002 Nov. 21(8):759-65. [QxMD MEDLINE Link].
Manabe K, Jo N, Tateno H, Shishidon N, Takahashi K, Iwashita K, et al. [A case of ring melanoma found while treating traumatic glaucoma]. Nihon Ganka Gakkai Zasshi. 2013 Apr. 117(4):364-70. [QxMD MEDLINE Link].
Berinstein DM, Gentile RC, Sidoti PA, et al. Ultrasound biomicroscopy in anterior ocular trauma. Ophthalmic Surg Lasers. 1997 Mar. 28(3):201-7. [QxMD MEDLINE Link].
Tönjum AM. Intraocular pressure and facility of outflow late after ocular contusion. Acta Ophthalmol (Copenh). 1968. 46 (5):886-908. [QxMD MEDLINE Link].
Iwamoto T, Witmer R, Landolt E. Light and electron microscopy in absolute glaucoma with pigment dispersion phenomena and contusion angle deformity. Am J Ophthalmol. 1971 Aug. 72(2):420-34. [QxMD MEDLINE Link].
Bai HQ, Yao L, Wang DB, Jin R, Wang YX. Causes and treatments of traumatic secondary glaucoma. Eur J Ophthalmol. 2009 Mar-Apr. 19(2):201-6. [QxMD MEDLINE Link].
Ta Chen Chang, MD, corresponding author* Elizabeth A. Vanner, PhD, * Danielle Fujino, MS, et al. Factors Associated With Laser Trabeculoplasty Response Duration: Analysis of a Large Clinical Database (IRIS Registry). Journal of Glaucoma. August 9, 2021. 30:902-910. [QxMD MEDLINE Link]. [Full Text].
Robin AL, Pollack IP. Argon laser trabeculoplasty in secondary forms of open-angle glaucoma. Arch Ophthalmol. 1983 Mar. 101 (3):382-4. [QxMD MEDLINE Link].
AlObaida I, Aljasim LA. Selective laser trabeculoplasty in patients with angle recession glaucoma: A small case series. Am J Ophthalmol Case Rep. 2020 Sep. 19:100835. [QxMD MEDLINE Link].
Fukuchi T, Iwata K, Sawaguchi S, Nakayama T, Watanabe J. Nd:YAG laser trabeculopuncture (YLT) for glaucoma with traumatic angle recession. Graefes Arch Clin Exp Ophthalmol. 1993 Oct. 231(10):571-6. [QxMD MEDLINE Link].
Mermoud A, Salmon JF, Straker C, Murray AD. Post-traumatic angle recession glaucoma: a risk factor for bleb failure after trabeculectomy. Br J Ophthalmol. 1993 Oct. 77(10):631-4. [QxMD MEDLINE Link].
Roy AK, Padhy D. Serous retinal detachment after trabeculectomy in angle recession glaucoma. GMS Ophthalmol Cases. 2015. 5:Doc15. [QxMD MEDLINE Link]. [Full Text].
Manners T, Salmon JF, Barron A, Willies C, Murray AD. Trabeculectomy with mitomycin C in the treatment of post-traumatic angle recession glaucoma. Br J Ophthalmol. 2001 Feb. 85(2):159-63. [QxMD MEDLINE Link].
Wang XY, Hu RR, Shen LP, Lu H, Gu YS. Combined trabeculectomy and vitrectomy for intractable glaucoma with severe ocular contusion involving the posterior segment. Chin Med J (Engl). 2011 Aug. 124(15):2316-20. [QxMD MEDLINE Link].
Jaya Kaushik, Jitendra Kumar Singh Parihar, Ankita Singh, Rakesh Shetty, Aanchal Singhal, Y V K Chaitanya, et al. Evaluation of primary Ahmed Glaucoma valve implantation in post-traumatic angle recession glaucoma in Indian eyes. International Ophthalmology. October 14, 2021. [QxMD MEDLINE Link]. [Full Text].
A Mermoud, J F Salmon, A Barron, C Straker, A D Murray. Surgical management of post-traumatic angle recession glaucoma. Ophthalmology. May 1993. 100:634-642. [QxMD MEDLINE Link]. [Full Text].
de Klerk TA, Au L. I-stent for treatment of angle recession with raised intraocular pressure. Clin Experiment Ophthalmol. 2011 Nov 2. [QxMD MEDLINE Link].

Media Gallery

Irregular widening of the visible ciliary body in a quadrant with angle recession.
Angle recession. Note the marked posterior displacement of the iris, with a wide ciliary body band posterior to the scleral spur.
Gonioscopic examination many years after blunt trauma in a patient with angle-recession glaucoma. Note the irregular contour of the iris, with loss of detail of angle structures. Classic findings of angle recession may become subtle or be obscured over time.

of 3

Author

Frank X Cao, MD Attending Ophthalmologist (Glaucoma), Millman-Derr Center for Eye Care

Frank X Cao, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, American Medical Association, American Society of Cataract and Refractive Surgery

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.

Martin B Wax, MD Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Research and Development, Head, Ophthalmology Discovery Research and Preclinical Sciences, Alcon Laboratories, Inc

Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, Society for Neuroscience

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

Andrew I Rabinowitz, MD Director of Glaucoma Service, Barnet Dulaney Perkins Eye Center

Andrew I Rabinowitz, MD is a member of the following medical societies: Aerospace Medical Association, American Academy of Ophthalmology, American Society for Laser Medicine and Surgery, American Academy of Ophthalmology, American Medical Association

Disclosure: Nothing to disclose.

Brian R Sullivan, MD Professor, Department of Ophthalmology, Chicago Stritch School of Medicine, Loyola University Medical Center

Brian R Sullivan, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgements

Supported in part by an unrestricted research grant from Research to Prevent Blindness, Inc., New York, NY

Dr. Sullivan has no financial interests in any of the products mentioned in this article, nor in any of the companies that manufacture or distribute them.

Sections Angle-Recession Glaucoma
Overview
Presentation
- History
- Physical
- Causes
- Complications
- Show All
DDx
Workup
Treatment
Medication
Questions & Answers
Media Gallery
References

Angle-Recession Glaucoma Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

Tables

Contributor Information and Disclosures

What would you like to print?