Aphakic Pupillary Block Differential Diagnoses

Updated: Feb 18, 2019
  • Author: Mitchell V Gossman, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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DDx

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