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Medical Author:

Brian R. Sullivan, MD

Medical Editor:

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.

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Angle recession is one of the most common complications after eye trauma. The exact incidence of angle recession in the United States has not been reported, but it has been described in more than 20% to 94% of eyes that have experienced blunt trauma.

• Angle recession occurring in association with traumatic hyphema (bleeding into the anterior chamber of the eye) occurs in 71% to 100% of cases.
• A 1987 study involving routine examination of asymptomatic (that is, no symptoms) boxers found at least unilateral angle recession in 19%, with 8% having angle recession in both eyes.

Worldwide, the incidence of eye trauma is similar to that found in the United States.

• A study of Australian adults older than 40 years yielded a lifetime cumulative rate of eye injury of 21.1%. Among men, those in rural areas had higher rates than those in urban areas (42.1% vs. 30.5%). In contrast to U.S. data, workplace injuries predominated at 60%, with home injuries closer to agreement with U.S. figures at 24%.
• The Israeli Ocular Injuries Study reported in 1988 that injuries occurring at home were the most frequent type of eye trauma in Israel.
• A 1995 study of eye trauma among Nigerians reported the rate of home injuries at 26.4%. This study identified women and children at the greatest risk of sustaining eye trauma during domestic activities.
• A 1996 report described a predominance of home injuries in Scotland.

As in the United States, the exact incidence of angle recession in other countries is unclear. Most reports verify that contusion injuries (direct blows to the eye) represent most eye trauma cases, but specific rates of angle recession and/or traumatic glaucoma are not well documented.

• One survey published in 1994 based on the results from gonioscopic examinations (see Angle Recession Glaucoma Diagnosis) of individuals older than 40 years in a community in South Africa reported a cumulative prevalence of angle recession of 14.6%.
• In this study, it was found that of eyes with angle recession involving all 360° of the iris, 8% had glaucoma, and the overall prevalence of glaucoma of eyes with any degree of angle recession was 5.5%.

Eye injury is a relatively common occurrence in people who are admitted to the hospital or present to the emergency department with major head trauma.

• In 1996, a study found that an annual cumulative incidence of serious eye trauma necessitating hospital admission was approximately 8 per 100,000 cases. Of those cases, approximately 13% had a poor visual outcome; 10.7% had a blinding outcome.
• In 1999, a study reported eye injuries in 55% of all facial injuries and in 16% of all major trauma cases.

Because angle recession glaucoma can have its onset years after the traumatic episode, estimating the resultant visual disability is difficult. Published data of visual outcomes following eye trauma usually only describe short-term results. The long-term incidence of significant vision loss or blindness from posttraumatic glaucoma has not been reported.

Angle recession glaucoma appears to affect all races equally. In general, African Americans may be at an increased risk for all types of glaucoma, particularly primary open-angle glaucoma (POAG).

• Because of the possible relationship of POAG with angle recession glaucoma, African Americans theoretically may be at an increased risk of glaucoma following eye trauma.
• One urban study published in 1991 found that, at a Los Angeles inner city hospital, African Americans experienced eye injuries more than twice as frequently as Hispanics. However, a comparison of rates of progression to angle recession glaucoma among different races has not yet been reported.

Among men and women, eye trauma occurs more often to men, outnumbering women by a ratio of 4 to 1. Therefore, presumably, angle recession and angle recession glaucoma develop most frequently in men.

• Women appear to be at a greater risk of sustaining eye injuries within the home environment.
• Among children, eye injuries occur more frequently in boys than in girls.

The risk of angle recession as a person gets older has not been formally described.

• Because the onset of symptoms is often delayed following a blunt eye injury, angle recession glaucoma is not usually diagnosed until middle to late adulthood. It may even be misidentified as POAG, since angle abnormalities may not be readily evident on examination. A distant or even forgotten history of eye trauma, particularly common among elderly persons, may result in the condition being underdiagnosed.
• Among adults, the risk of injury appears to decline steeply with advancing age. Studies of urban populations have indicated that elderly persons sustained only 1.6% of eye trauma, and, for persons older than 65 years, eye injuries were most often due to a fall.
• Angle recession glaucoma has been described in childhood, but eye trauma generally occurs during young adulthood. The annual incidence of pediatric eye injuries has been reported at 15 per 100,000 children.

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