Kids are active. They play sports, ride bikes, and explore their world. But with that comes an element of risk, and not always in the way you might expect. Sometimes a fall can have long-term consequences, and what may seem like a minor eye injury at the time could turn into something much worse: traumatic glaucoma. Being aware of this potential problem can help prevent it.

The Angle is that area of the eye where the iris and the cornea meet. Angle recession is when that area narrows or closes after a head or eye injury. This does not happen often, but it does happen. Occasionally, it prevents the eye fluid from properly draining, which in up to 20% of angle-recession cases leads to what is called traumatic glaucoma.

Traumatic glaucoma can develop well after the original injury. A hit in the eye from a baseball at age ten, for example, might not manifest as glaucoma until years later. What’s more, because the underlying injury has no connection with glaucoma, there is little chance the patient will be tested or monitored for glaucoma in the months following the injury. This can mean the patient could suffer optic nerve damage and vision loss long before they are ever diagnosed.

Traumatic Glaucoma is Preventable

Eye injury does not have to lead to traumatic glaucoma if the patient has regular eye examinations with an eye doctor who knows what to look for. Make sure you mention any eye or head injuries, as well as any eye surgeries or family history of eye disease. At each appointment, the doctor should screen for angle recession, and monitor the eye for any sign of developing glaucoma, such as increases in fluid pressure. If they don’t do that, ask!

Testing and Treatment

Because glaucoma is a known risk after an eye or head injury, there is no reason for patients or their doctors not to be on the alert for signs of trouble and to do preventative tests. Before signs of glaucoma develop, there are two tests that are typically used, gonioscopy and a standard visual field test.

Gonioscopic procedures use a special contact lens to determine whether the angles are widened or recessed. This usually happens 3-6 months after injury, as the result of a hyphema or bleed into the anterior part of the eye near the drain. It is also possible to develop post-injury inflammation and iris adhesions, which block drainage and can cause angle closure. If the eye is severely injured and gonioscopy cannot be used, the doctor might use high-frequency ultrasound biomicroscopy to test the angle.

The second test is a visual field test that checks the peripheral vision to rule out any glaucoma-related visual field defects. The frequency of the tests is determined by the patient’s risk of developing glaucoma. The lower the risk, the lower the frequency of the visual field tests.

Treatment generally falls into two categories: medicated eyedrops and surgery. The eyedrops reduce pressure inside the eye and require frequent follow-up appointments to monitor the eye pressure. Surgery, either laser or conventional, may be necessary to allow the eye fluid to drain. when the medicine has failed to reduce eye pressure, and when the risk of vision loss outweighs the risk of surgery. The most typical types of surgery include laser treatment, trabeculectomy, or drainage implant surgery.

While traumatic glaucoma is a real possibility, it can be diagnosed and treated early if you make sure to look for it after suffering an eye or head injury. If you or your children are at risk of eye or head injury from sports, work, or other activities, then consider investing in goggles, safety glasses, and helmets. These are a cheap alternative to the costs, both financial and personal, of glaucoma.

First posted on January 26, 2017; Reviewed on May 8, 2022