Ocular Complications 1 Month After Being Punched

Rachel N. Brackley, OD; Case Series Editor: Jean Marie Pagani, OD

Disclosures

December 17, 2013

Treatment and Clinical Care

The treatment of angle recession glaucoma differs depending on the progression of the clinical findings. If a patient has abnormal gonioscopic findings in angle recession with a normal IOP, optic nerve appearance, and visual fields, no treatment is warranted, but yearly monitoring is required. If any of these clinical findings progress, treatment must be initiated.

Treatment of angle recession glaucoma is similar to the treatment of primary open-angle glaucoma.[1] Pharmacologically lowering the pressure with topical agents is the first line of treatment. Traditionally, treatment was an aqueous suppressant including beta blockers, carbonic anhydrase inhibitors, and alpha-adrenergic agonists.[2] More recently the use of prostaglandin agonists has been suggested as it increases uveoscleral outflow, theoretically bypassing the dysfunction of the trabecular meshwork.[3,4] Mitotics are to be used with caution because of paradoxic increases in IOP.

Laser trabeculectomy is not a successful treatment in angle recession glaucoma, and Nd:YAG laser trabeculopuncture has limited success. If surgical intervention is warranted, filtering surgeries as well as tube shunts are used, but outcomes are variable with these procedures.[2,3]

If treatment is initiated, follow-up is similar to a patient with primary open-angle glaucoma. Of particular importance in future examinations is careful observation of the other eye because of the significant risk for development of primary open-angle glaucoma. In approximately 50% of the cases, an IOP elevation will occur in the other eye, necessitating bilateral treatment.[2]

In this case, the patient was treated with travoprost 0.004%, 1 drop OD at bedtime. A visual field OCT of the optic nerve head and optic nerve head photos were ordered. At follow-up, the IOP in the affected eye had risen to 34 mm Hg as a result of noncompliance with the topical drops.

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