“It’s Been One Week Since You Looked at Me”: Increased IOP in Traumatic Angle Recession Withou...
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Lisa Hwang, M.D. 1 Sharmila Srinivasan, M.D. 1 Jonathan Levine, M.D. 1, 2 - PowerPoint PPT Presentation


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“It’s Been One Week Since You Looked at Me”: Increased IOP in Traumatic Angle Recession Without Hyphema. Lisa Hwang, M.D. 1 Sharmila Srinivasan, M.D. 1 Jonathan Levine, M.D. 1, 2 Assumpta Madu, M.D., MBA, PharmD 1, 2 1 Department of Ophthalmology, Bronx Lebanon Hospital Center

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“It’s Been One Week Since You Looked at Me”: Increased IOP in Traumatic Angle Recession Without Hyphema

Lisa Hwang, M.D.1

Sharmila Srinivasan, M.D.1

Jonathan Levine, M.D.1, 2

Assumpta Madu, M.D., MBA, PharmD 1, 2

1Department of Ophthalmology, Bronx Lebanon Hospital Center

2Department of Ophthalmology, Montefiore Medical Center

Albert Einstein College of Medicine


Purpose
Purpose IOP in Traumatic Angle Recession Without Hyphema

  • To describe a case of a 13 year old male status-post blunt trauma to the left eye without hyphema with increased IOP and traumatic angle recession within 1 week of injury.


Methods case report
Methods: Case Report IOP in Traumatic Angle Recession Without Hyphema

  • Patient presented to the ER within 1 day of being hit with a rock in the left eye.

  • Visual acuity on presentation was 20/20 OD and count fingers OS.

  • Pupils: OS dilated, nonreactive, no sphincter tears noted.

  • A/C: 4+ cells without hyphema

  • Tonometry 10 mmHg OD, 13 mmHg OS.

External photograph of patient’s left eye 2 days after presentation.


Results
Results IOP in Traumatic Angle Recession Without Hyphema

  • Fundus: Vitreous hemorrhage OS. Poor view of the fundus.

  • A B-scan was performed: No retinal detachment was noted. However, there was a slight elevation suggestive of choroidal rupture.

B scan OS


Retina exam
Retina Exam IOP in Traumatic Angle Recession Without Hyphema

  • Patient was noted to have a choroidal rupture OS when seen by retina 1 day later.

Day 2: Fundus photo OS showing choroidal rupture.


Fluorescein angiogram
Fluorescein Angiogram IOP in Traumatic Angle Recession Without Hyphema

FA day 14: Normal fundus OD. OS: choroidal rupture.


Exam 1 week later
Exam 1 week later IOP in Traumatic Angle Recession Without Hyphema

  • Within one week of the previous exam, the patient had an increased IOP of 35 mmHg OS and 10mm Hg OD. He was started on Dorzolamide/timolol.

  • UBM showed a deep angle OD and angle recession OS.

UBM OS

UBM OD


Conclusion
Conclusion IOP in Traumatic Angle Recession Without Hyphema

  • Angle recession after hyphema is known to cause increased IOP within 10-30 days due to trabecular injury and scarring.

  • This patient without hyphema or RD with intact posterior hyaloid had angle recession and high IOP within 1 week of trauma.

  • UBM should be performed to evaluate for abnormal angle structure and predisposition for angle recession. The patient’s abnormally wide angle may have contributed to the increased risk of angle recession.


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