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

Lisa Hwang, M.D.Lisa Hwang, M.D.11

Sharmila Srinivasan, M.D.Sharmila Srinivasan, M.D.11

Jonathan Levine, M.D.Jonathan Levine, M.D.1, 21, 2

Assumpta Madu, M.D., MBA, PharmDAssumpta Madu, M.D., MBA, PharmD 1, 1, 22

11Department of Ophthalmology, Bronx Lebanon Hospital Department of Ophthalmology, Bronx Lebanon Hospital CenterCenter22Department of Ophthalmology, Montefiore Medical CenterDepartment of Ophthalmology, Montefiore Medical CenterAlbert Einstein College of MedicineAlbert Einstein College of Medicine

PurposePurpose To describe a case of a 13 year old To describe a case of a 13 year old

male status-post blunt trauma to the male status-post blunt trauma to the left eye without hyphema with left eye without hyphema with increased IOP and traumatic angle increased IOP and traumatic angle recession within 1 week of injury.recession within 1 week of injury.

Methods: Case ReportMethods: Case Report Patient presented to the ER Patient presented to the ER

within 1 day of being hit within 1 day of being hit with a rock in the left eye.with a rock in the left eye.

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

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

A/C: 4+ cells without A/C: 4+ cells without hyphemahyphema

Tonometry 10 mmHg OD, Tonometry 10 mmHg OD, 13 mmHg OS.13 mmHg OS.

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

ResultsResults Fundus: Vitreous Fundus: Vitreous

hemorrhage OS. Poor hemorrhage OS. Poor view of the fundus. view of the fundus.

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

B scan OS

Retina ExamRetina Exam Patient was noted Patient was noted

to have a choroidal to have a choroidal rupture OS when rupture OS when seen by retina 1 seen by retina 1 day later.day later.

Day 2: Fundus photo OS showing choroidal rupture.

Fluorescein AngiogramFluorescein Angiogram

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

Exam 1 week laterExam 1 week later Within one week of Within one week of

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

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

UBM OS

UBM OD

ConclusionConclusion Angle recession after hyphema is known to Angle recession after hyphema is known to

cause increased IOP within 10-30 days due cause increased IOP within 10-30 days due to trabecular injury and scarring.to trabecular injury and scarring.

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

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