What causes aqueous misdirection?

The precise underlying mechanism of aqueous misdirection is unknown. Generally, it is felt to result from diversion of aqueous flow into the posterior segment. This diversion of fluid results from an abnormal relationship between the ciliary body processes, lens, and anterior vitreous.

What does malignant glaucoma mean?

In its classic form, malignant glaucoma is rare but one of the most serious complications of glaucoma filtration surgery in patients with narrow-angle or angle-closure glaucoma. The term malignant glaucoma refers to a sustained ongoing process that is difficult to treat and characteristically progresses to blindness.

What is inverse glaucoma?

Urbanek had coined the term inverse glaucoma to describe the pupillary block caused by miotics. Miotics cause ciliary muscle contraction, slackening the zonules, causing forward movement of the crystalline lens, thus shallowing the anterior chamber and increasing the pupillary block.

What is Phacomorphic glaucoma?

Phacomorphic glaucoma is a lens-induced secondary angle closure glaucoma that may occur as a result of mature cataract formation.

What is an iris bombe?

Iris bombe is a condition in which there is apposition of the iris to the lens or anterior vitreous, preventing aqueous from flowing from the posterior to the anterior chamber. The pressure in the posterior chamber rises, resulting in anterior bowing of the peripheral iris and obstruction of the trabecular meshwork.

What is reverse pupil block?

“Reverse pupillary block has been termed to explain the concave iris configuration in eyes with PDS and pigmentary glaucoma. During an eye blink, a small aliquot of aqueous is burped from the posterior chamber to the anterior chamber, resulting in increased pressure in the anterior chamber.

How is malignant glaucoma diagnosed?

Malignant glaucoma is diagnosed when there is shallowing of the central (axial) anterior chamber in association with increased intraocular pressure (IOP) and normal posterior segment anatomy.

How is malignant glaucoma treated?

The initial treatment of malignant glaucoma is the use of cycloplegia to move the lens-iris diaphragm backwards and widen the middle segment of the eye, aqueous suppressants to reduce the flow of aqueous into the vitreous cavity and hyper osmotic agents to reduce vitreous volume.

What is Weill Marchesani syndrome?

Weill Marchesani syndrome is a rare genetic disorder of connective tissue characterized by abnormalities of the lens of the eye, short stature, an unusually short, broad head (brachycephaly) and joint stiffness.

Why Atropine is used in malignant glaucoma?

Cycloplegic agents, including tropicamide, cyclopentolate, and topical atropine, paralyze the sphincter muscle of the ciliary body, increasing zonular tension with flattening and posterior movement of the lens and deepening the anterior chamber.

How is Phacolytic glaucoma treated?

The definitive treatment of phacolytic glaucoma (PG) is cataract extraction. Extracapsular cataract extraction (eg, phacoemulsification) with an intraocular lens implant has largely replaced intracapsular cataract extraction as the procedure of choice.

Can glaucoma be caused by trauma?

As a result of an immediate injury, traumatic glaucoma is most commonly caused by blunt trauma, which is an injury that doesn’t penetrate the eye, such as a blow to the head or an injury directly on the eye.

What kind of glaucoma is aqueous misdirection?

This article is from May 2004 and may contain outdated material. Aqueous misdirection, or malignant glaucoma, is a rare type of secondary angle-closure glaucoma most commonly encountered after filtering surgery. The syndrome (also known as ciliary block glaucoma) also can occur spontaneously or following any type of intraocular surgery.

What do you need to know about aqueous misdirection?

Aqueous misdirection is a diagnosis of exclusion, and requires exclusion of other clinical entities such as choroidal hemorrhage, choroidal effusion, and pupillary block. Elevation of intraocular pressure and axial shallowing of the anterior chamber from posterior pressure characterize aqueous misdirection.

What does axial shallowing in aqueous misdirection mean?

All other possible causes of shallow anterior chamber must be ruled out, as aqueous misdirection is a rare phenomenon and one that is established by a diagnosis of exclusion. Axial shallowing means that both the peripheral and central anterior chamber should be shallowed, with anterior displacement of the lens or lens implant.

What are symptoms of aqueous misdirection in the eye?

If filtration surgery is present a Seidel test should be performed to exclude a wound leak, particularly if the intraocular pressure is not significantly elevated. Symptoms can include redness, eye pain, and decreasing vision (especially in patients with an ocular history of angle closure, eye procedures/surgeries, inflammation or infection).

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