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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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The treatment of angle recession glaucoma depends on how severely the eye is injured and how well the eye heals following this injury. If one is diagnosed with angle recession, then treatment will be similar to that of primary open-angle glaucoma (POAG). (For a complete discussion of the treatment of POAG, see Primary Open-Angle Glaucoma.)

The treatment of angle recession glaucoma includes monitoring IOP as well as reducing it through the use of medicated eyedrops.

• Eyes with normal IOP and with angle recession involving more than 180° of the iris are routinely examined at intervals for an indefinite time period to monitor for the development of later angle recession glaucoma.
• If the IOP in the eye is abnormally elevated, an ophthalmologist will decide whether or not to begin medical treatment based on the patient's overall risk of vision loss.
• To assess this risk, the eye doctor takes into account the patient's age, how high his or her IOP is elevated, the appearance of the optic nerve, and the findings of the visual field tests.
• Treatment is most often indicated when IOP is greater than 25 to 28 mm Hg and/or when changes in the optic nerve or the visual field are documented over time.

• Each person's response to medical treatment is different.
• Treatment with medication in the form of eyedrops may be effective for many years in cases of mild-to-moderate angle recession, while elevated IOP in eyes with extensive injury to the angle may eventually no longer respond to medications.
• Severe cases of angle recession may not respond to even aggressive medical treatment and typically have a poorer overall prognosis.

Medications

The goal of therapy is to reduce IOP, typically by using medication in the form of eyedrops. These medications must often be used for a long time. Each person's response to medication varies and changes with time, and IOP control may deteriorate despite the use of multiple medications. Therefore, IOP is continually monitored, more frequently whenever medications are changed or discontinued.

• The preferred drugs for lowering IOP include beta blockers, alpha agonists, and carbonic anhydrase inhibitors, all of which reduce the amount of fluid (aqueous humor) produced within the eye. Beta blockers are typically the first choice, and alpha agonists and/or carbonic anhydrase inhibitors may be added later.
• Prostaglandin analogs and miotics increase the outflow of fluid (aqueous humor) from the eye. Prostaglandin analogs may be useful for the treatment of angle recession glaucoma, although they are usually not as effective as in cases of POAG. Miotics are not routinely recommended.

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