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Recession of the angle: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Epidemiology of angle recession
Recession of the angle develops with a blunt or penetrating injury of the anterior segment. The risk of developing glaucoma during the recession of the angle is proportional to the extent of damage to the ciliary body, with a frequency of 10% with a break length greater than 180 °. Glaucoma develops from a few months to several years after trauma. In patients with glaucoma, a tendency to open-angle glaucoma is observed in recession of the angle, as evidenced by the fact that up to 50% of these patients subsequently have increased intraocular pressure of the second eye.
Pathophysiology of angle recession
Recession of the angle occurs when the connection between the circular and longitudinal muscle layers of the ciliary body is broken. Glaucoma in the recession of the angle develops due to a violation of the outflow of intraocular fluid. To the obstruction of the outflow path leads to direct damage to the trabecular network or descemet-like endothelial proliferation in the trabecula region.
Symptoms of angle recession
Patients have a history of an episode of a recent or old trauma to the affected eye. The disease can occur asymptomatically or with pain, photophobia and decreased vision due to increased intraocular pressure. Defects of visual fields or an afferent pupillary defect are determined due to glaucomatous optic nerve damage. In addition, during the examination, it is possible to identify lesions of other eye or orbital tissues.
Diagnosis of angle recession
Biomicroscopy
When examining with a slit lamp, signs of a previous trauma are determined: scars on the cornea or staining it with blood, cataracts, fakodenes, ruptures of the sphincter of the iris or ruptures in the area of its root (iridodialysis).
Gonioscopy
With gonioscopy, the uneven expansion of the ciliary body strip is seen. You can see signs of ruptured ciliary processes or an increase in the elevation of the scleral spur. Normally, the ciliary body should be approximately uniform in size along the entire circumference, not as wide as the trabecular network. The diagnosis is helped by comparison with a healthy eye.
Rear Pole
The posterior pole may show signs of a previous blunt or penetrating injury: choroidal gaps, retinal detachment, or vitreous hemorrhage. In addition, the asymmetry of the optic nerve disc excision due to increased intraocular pressure is determined on the affected eye.
Special tests
In the study of visual fields, scotoma is identified by the glaucomatous type.
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Treatment of angle recession
Patients with a recession angle, diagnosed after a trauma in gonioscopy, must be constantly monitored to identify the initial glaucoma. Elevation of intraocular pressure, as a rule, is difficult to control. In the initial stage, they are treated with drugs that suppress the secretion of watery moisture. If necessary, add hyperosmotic drugs. Myotics often worsen the condition during recession of the angle, since they reduce the out-scleral outflow in cases where the control of intraocular pressure depends on it. In patients with recession of the angle, the effectiveness of laser trabeculoplasty is limited, and a gentle filtering operation is often necessary to control intraocular pressure.