Secondary

Glaucoma
 Phacomorphic Glaucoma

Acute secondary angle closure glaucoma

Precipitated by an intumescent cataractous lens
Etiology
Rapid development of cataractous changes
Traumatic rupture of lens capsule
Swollen lens obliterates the angle, by forcing the root of iris towards cornea
Presentation
Similar to acute angle closure glaucoma
Pain, headache, vomiting, red eye
Preceding H/O gradual diminution of vision
H/O cataract surgery in opposite eye may be present
Signs : CCC, Hazy cornea, shallow AC, dilated pupil
 Phacomorphic Glaucoma

Treatment
IV Mannitol
Oral Acetazolamide
Topical Timolol eye drops
Avoid Pilocarpine drops
Once IOP is under control- Cataract surgery
Phacomorphic Glaucoma
Phacomorphic Glaucoma

(a) Traumatic anterior dislocation of lens with pupillary block

glaucoma
(b) lens particle glaucoma
 Phacolytic Glaucoma

Open angle glaucoma

Occurring in hypermature (Morgagnian) cataract
Etiology
Obstruction of trabecular meshwork by HMW lens proteins which leak through
lens capsule into aqueous
Presentation
Painful red eye, h/o gradual diminution of vision,
Morgagnian cataract
Treatment Cataract surgery
Phacolytic Glaucoma
 Traumatic Glaucoma

Traumatic hyphema may be associated with increase in IOP

Due to trabecular blockage by RBCs
Hyphema more than half of AC- Iris
If hyphema with raised IOP persist for more than 5 days- it will lead to
corneal staining
Traumatic Glaucoma

Treatment
Beta blockers- Timolol
Oral Acetazolamide
IV Mannitol- if IOP is very high
Topical steroids
Surgery- if no response
– AC Wash & hyphema evacuation
Traumatic glaucoma

Traumatic Hyphema
 Angle Recession Glaucoma

Following blunt trauma to the eye

Due to rupture of the face of the ciliary body & damage to trabecular
meshwork
Usually develops 2-3 months after injury, may take years
Presentation - Uniocular- rise in IOP in affected eye
Behaves like open angle glaucoma
Treatment
Medical management- Timolol , Trabeculectomy
Angle Recession Glaucoma

Normal angle Traumatic angle recession

Neovascular Glaucoma

Occurs as a result of iris neovascularization (Rubeosis Iridis)

Etiology
Central retinal vein occlusion
Proliferative diabetic retinopathy
Diffuse retinal ischemia ➦ release VEGF ➦ Diffusion into anterior segment
➦ Rubeosis Iridis
Rare conditions
Long standing RD, Chronic intraocular inflammation
Neovascular Glaucoma

Presentation - Pain, redness, raised IOP

Slit lamp- Iris neovascularization
Gonioscopy- Neovascularization involving angle
Treatment
Topical: Timolol /Dorzolamide, Steroids, Atropine/Homatropine
Avoid Pilocarpine
PRP- Pan Retinal Photocoagulation
Intravitreal VEGF
Transscleral Cryotherapy/ Diode LASER
 Neovascular Glaucoma

If no response
Trabeculectomy with Mitomycin C
Glaucoma drainage devices
Painful blind eye
Retrobulbar alcohol injection
Enucleation
Neovascular Glaucoma