Angle Recession Glaucoma

Definition:

Angle recession glaucoma (ARG) is a secondary open angle glaucoma that is characterized by recession of anterior chamber angle.

In simpler words, ARG is group of ocular disorders that occur due to blunt trauma to the eye and result in abnormal elevation of eye pressure (intraocular pressure (IOP)), and increased risk of damage to the optic nerve.

Characteristics of angle recession glaucoma

• Angle recession glaucoma can occur either early after non-penetrating ocular trauma or may develop 50 years after the injury. It is very commonly seen that the patient has even forgotten about the trauma and complains of vision loss during their visit to eye clinic. In these cases, ophthalmologist helps the person recall any incident of eye trauma to find out the cause of vision loss.
• Not all eyes with angle recession develop glaucoma. It may or may not lead to glaucoma and patient remains stable even after angle recession. But all these cases need to be monitored regularly to avoid any unwanted complication at any time.

Risk factors of angle recession glaucoma

Eye trauma is an invariable part of angle recession that may cause glaucoma. But there can be so many reasons or risk factors of eye trauma that can lead to angle recession. The risk factors include:

• Eye trauma that does not penetrate the eye and occur from high-speed or fast-moving blunt objects or projectiles, like:
  • Airbags
  • Fists
  • Stones
  • Balls
  • Champagne stoppers
  • Bungee cords
  • Tree branches
• Most often, blunt trauma to eye can occur as a result of any of the following:
  • Sports injuries (e.g., boxing, paintball)
  • Motor vehicle accidents (e.g., airbag deployment)
  • Assaults
  • Falls
  • Military combat injuries
  • Accidents (e.g., industrial, farm, home)
  • Other (e.g., school accidents, natural disasters)
• Consequent transient or prolonged elevation of IOP

Symptoms of angle recession glaucoma

As with almost all of the glaucoma types, angle recession glaucoma is also asymptomatic till the time there is significant vision loss. In most of the cases, the trauma to eye had occurred long back and patient forgets about the incident. During eye examination, ophthalmologist finds out certain abnormalities in the eye and could help the person in recalling the forgotten incident to find out the cause of angle recession glaucoma. In emergency cases, patient comes to the eye clinic and may complain any of the following symptoms:

• Iritis
• Extreme eye pain
• Single or affected eye blindness

Diagnosis of angle recession glaucoma

Most of the cases of angle recession glaucoma are found either on routine eye examination or due to sudden vision loss. Although most of the cases of glaucoma are asymptomatic but to find out the cause of glaucoma, it is required to evaluate any eye trauma history from the patient. The only reason for angle recession glaucoma is eye trauma but that can be immediate or past history. Previous trauma can be a reason that leads to development of angle recession without showing any symptoms.

In addition to trauma history, a thorough slit-lamp examination and a careful, detailed characterization of the angle structures via gonioscopic examination are required to evaluate the internal structures of eye for angle recession glaucoma.

Treatment of angle recession glaucoma

The initial treatment of angle recession glaucoma is medication similar to the ones that is used to treat open-angle glaucoma. It includes:

• Aqueous suppressants such as α-agonists
• Topical carbonic anhydrase inhibitors
• β-blockers
• Judicious use of steroid therapy with fast tapering

In cases where medical therapy fails to control IOP, filtering surgery may be indicated. Trabeculectomy with antimetabolites is also effective in controlling the IOP. But it all depends upon the patient and disease condition to conclude the type of surgery that would be effective in controlling the eye pain and other symptoms.

Outlook of angle-recession glaucoma

It is a very sudden situation and its resolution should also be immediate as it can lead to devastating consequences like glaucomatous optic neuropathy. Early diagnosis and aggressive intervention to lower the IOP plays the most important role in controlling the condition from getting worse. After resolution of primary sequel of the injury, physician counsels and educates the patient about their lifetime risk of developing glaucoma. This counselling is very important to make patient aware of the careful lifelong monitoring of their IOP and examinations of their optic nerves to prevent glaucoma.