August 2025 - 1
Author: Dr Eamonn Fahy
A 38-year-old male has been referred to you for follow up, 6 months after blunt trauma to his left eye. You perform gonioscopy and see the following iridocorneal angle features in his left eye (see image). The right eye angle is normal on gonioscopy. The visual acuity without glasses is 6/6 on the right and 6/7.5 on the left. The intraocular pressures are 12 on the right and 19 on the left. Pupil responses are normal. He complains of intermittent blurred vision and mild discomfort in the left eye but is currently asymptomatic.
What are the next best steps for this patient?
A - Refer to an ophthalmologist for immediate assessment
Oops! Try again
B - Perform visual fields and OCT to rule out glaucoma
CORRECT!
C - Give lubricant eye drops and review again in 1 year
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D - Discharge patient and instruct to present again if any further symptoms
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Answer B
This is a case of angle recession following blunt trauma. The angle recession is extensive and covers almost 360 degrees of the iridocorneal angle. The optimal approach here would be to perform visual fields and OCT to rule out glaucoma. If there were abnormalities, it would be reasonable to refer to an Ophthalmologist.
Screening for glaucoma following blunt trauma is a common Optometry referral. Up to 60% of eyes with blunt trauma will develop some degree of angle recession, and up to 6% of patients with angle recession will develop glaucoma. The risk of glaucoma is increased in cases where the extent of angle recession exceeds 180 degrees.
Glaucoma in the context of angle recession can occur may years after trauma, and ongoing annual surveillance with an optometrist is necessary to monitor intraocular pressures (IOP). In this case, despite normal IOP, the patient describes symptoms that could reflect intermittent high IOP and thus proceeding with glaucoma screening is indicated.
