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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 • 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 • 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 • 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 • 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 FA day 14: Normal fundus OD. OS: choroidal rupture.
Exam 1 week later • 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 • 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.