Angle Recession Glaucoma

This type of glaucoma can develop after an injury, or trauma, to your eye. Although it can’t be cured, there are treatments to stop it from stealing your sight if it’s diagnosed early.

Glaucoma is a group of eye diseases that damage the optic nerve. This nerve “cable” runs from the back of your eye to your brain and sends images so you can see.

What Happens

When your eye works as it should, clear fluid inside your eye flows around the front part and drains through tiny canals near the outer edge of the iris, the coloured part of your eye. This spot is called the “drainage angle.” Proper drainage keeps the pressure inside your eye at a steady and healthy level.

Sometimes, an eye injury can damage this drainage system, a condition called angle recession.

When the fluid in your eye can’t circulate normally, it starts to back up, much like water in a clogged sink drain does. The extra fluid causes the pressure inside your eye to go up. Over time, pressure that’s too high can damage your optic nerve.

Not every injury leads to glaucoma. But statistics show that up to 20% of eyes with angle recession will get angle-recession glaucoma.

Causes

A blunt trauma to the eye is the most common cause of angle recession. That’s a bruising type of injury like getting punched, elbowed, or hit with a ball in the eye.

The blow’s force can tear the tissue at the inner peripheral edge of the iris and in your eye’s ciliary body. That’s the part that makes the fluid. The tear can lead to bleeding inside the eye. Then blood and other pieces of waste may clog up the drainage system and raise eye pressure. The rise in pressure won’t last in most cases. Treatment can help keep eye pressure at a safe level until the excess blood clears out.

Sometimes, the ripped or damaged drain canals build up scar tissue. The scarring blocks the flow of fluid and may lead to glaucoma. If more than half of the drain is damaged, you chance of getting the disease is higher.

Symptoms

You may not have any symptoms at first. With glaucoma, high eye pressure slowly damages the tiny fibres in your optic nerve. Over time, you can develop blind spots in your vision. But you may not notice them until most of your optic nerve fibres are dead.

Usually you lose your peripheral, or side, vision first. If all the fibres in your optic nerve die, you go blind in that eye.

In angle recession glaucoma, the process is the same. After the injury, years could pass before you notice any signs of vision loss. Some people may even forget the injury happened by the time glaucoma develops.

Once your eye heals from the trauma, you’ll need yearly eye exams with an ophthalmologist (a medical doctor who specializes in eye care and surgery). He will screen for angle recession and monitor the eye for any signs of glaucoma.

Diagnosis

Your ophthalmologist will ask you about your medical history and give you a complete eye and vision exam. He will check your eye pressure, which is a normal part of any medical eye exam. To check the drainage angle of your eye, he will do a test called a gonioscopy. After numbing it with drops, the doctor will put a special contact on your eye. Then he’ll use a beam of light to see if there are any blockages or damage to the drainage angle that could raise eye pressure.

You’ll also get a “visual field” test to check your peripheral vision for losses you may not notice yourself. You doctor may also do other tests to check your optic nerve for damage and measure the pressure inside your eye.

Treatment

Doctors can’t reverse the damage caused by glaucoma. The goal, instead, is to lower pressure in your eye to help stop further damage and slow or prevent more vision loss.

Treatment for angle recession glaucoma depends on how serious the eye injury was. Your doctor may prescribe medications, suggest laser treatment, or consider surgery.

Medication: Prescription eye drops are usually the first step in treatment. For angle recession glaucoma, your doctor may prescribe a drop that causes your eye to make less fluid. That helps lower pressure. If your eye pressure is high soon after the injury, your doctor may recommend eye exams every 4 to 6 weeks to monitor the pressure.

Laser treatment: An eye surgeon will use a laser beam to open drainage channels in your eye. This way, fluid can flow out more easily and eye pressure goes down. Doctors usually recommend laser treatment after you have tried the maximum amount of medicine without lowering the pressure enough. Your ophthalmologist may be able to do the procedure in her office or you may need to go to an outpatient surgery centre.

Surgery: One procedure, called a trabeculectomy, creates a new opening in the white of your eye (or sclera) for fluid to drain. In some cases, medicines called antimetabolites are needed with this surgery to prevent scarring and improve the success rate. Another option might be to implant a tiny drainage tube in your eye to reduce pressure. Though surgery has shown good results for angle recession glaucoma, the success rate is lower for this type than for other forms of the disease.

Can You Prevent It?

You might not be able to prevent it in every case. But you can drastically cut your risk.

Eye injuries cause angle recession glaucoma. So if you protect your eyes, you can help prevent the condition. Thousands of eye accidents happen every day. Using safety eyewear, for instance when you’re at work or when you play sports, can prevent about 90% of injuries.

If you have had a serious blow to the eye make sure you have regular eye exams checking for glaucoma for the rest of your life.