Angle Recession Glaucoma
Brian R. Sullivan, MD
Andrew A. Dahl, MD, FACS
Andrew A. Dahl, MD, FACS
Andrew A. Dahl, MD, is a board-certified ophthalmologist. Dr. Dahl's educational background includes a BA with Honors and Distinction from Wesleyan University, Middletown, CT, and an MD from Cornell University, where he was selected for Alpha Omega Alpha, the national medical honor society. He had an internal medical internship at the New York Hospital/Cornell Medical Center.
Angle Recession Glaucoma Overview
Traumatic glaucoma refers to a group of ocular disorders that occur after the eye undergoes trauma. Following this trauma, different mechanisms can cause an abnormal elevation of pressure inside the eye, called intraocular pressure (IOP), and increase the risk of damage to the optic nerve.
The angle of the eye is the anatomical portion of the eye that contains the structures that allow fluid to drain out of the inside of the eye. The angle is located between the peripheral cornea and the peripheral iris. The angle contains the trabecular meshwork, which acts as a filtration system for the aqueous fluid draining from the eye. In cases of blunt trauma, the angle can be subjected to shearing forces, injuring the trabecular meshwork and impairing its function. This is called angle recession. The angle of the eye can be visualized though a procedure known as gonioscopy. The angle cannot be seen by the ophthalmologist on examination with only a flashlight or a slit lamp.
Angle recession glaucoma is a form of traumatic glaucoma. It is classified as a type of traumatic secondary open-angle glaucoma. This means that the open-angle glaucoma occurs due to a specific cause, in this case a traumatic event. Angle recession, with or without a diagnosis of glaucoma, may result after the eye experiences blunt trauma.
Although angle recession glaucoma is uncommon, it may not be readily diagnosed because the onset of symptoms or the discovery of the anatomical abnormality is often delayed. The eye injury might have occurred a long time ago and, perhaps, has even been forgotten by the person.
Of those eyes with angle recession, only some develop glaucoma. In those that do develop glaucoma, the onset is extremely variable, ranging from immediately following the trauma to months or even many years later.
The risk of eventual progression to glaucoma is generally accepted to be proportionate to the extent of the angle recession, although the presence of angle recession alone is not a good predictor for the occurrence of glaucoma. The anatomical angle is present for 360° between the peripheral cornea and the peripheral iris.
In the United States, over 1 million Americans experience eye injuries each year. Blunt eye injuries are estimated to account for over 60% of all episodes of eye trauma. Although injuries often occur to only one eye, the incidence rate of trauma to both eyes is as high as 27%.
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Traumatic glaucoma refers to a heterogeneous group of posttraumatic ocular disorders with different underlying mechanisms that lead to the common pathway of abnormal elevation of intraocular pressure (IOP) and increased risk of optic neuropathy.