“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.