Ocular Complications 1 Month After Being Punched

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

Disclosures

December 17, 2013

Discussion

Angle recession can occur after forced blunt trauma to an eye. The force of the trauma causes a tear between the circular and longitudinal fibers of the ciliary body. Other structures of the angle are damaged as well. The disruption of the trabecular meshwork increases the resistance of aqueous humor outflow, raising the IOP.[5,6] Angle recession is more likely to be present if a traumatic hyphema occurred at the time of injury.

Not all patients with angle recession will progress to glaucoma. A risk factor in the development of glaucoma is the degree of angle recession. When more than 180° of the angle is affected, the likelihood that glaucoma will develop is higher. The onset of glaucoma can vary from several weeks to many years after the injury.[2,5] The fellow eye must be monitored closely for delayed development of primary open-angle glaucoma.

In summary, a history of blunt trauma to the eye necessitates monitoring of the angle for recession. If angle recession is present, it is essential to monitor for any changes in the pressure, visual field, or optic nerve head appearance. Vision loss from angle recession glaucoma is avoidable with the proper observation and treatment.

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