Traumatic glaucoma describes a group of conditions that can occur when either a blunt or penetrating eye injury results in secondary glaucoma. Approximately 2.5 million people in the U.S. experience traumatic eye injuries each year, with most of those occurring in young people playing sports, and in older adults as the result of falls. 

According to the American Academy of Ophthalmology, the risk of developing glaucoma after a blunt injury is 3.39%, while the risk after a penetrating injury is about 2.67%.*

What are some forms of glaucoma as a result of blunt trauma?

A blunt trauma is an event, such as a blow to the head, that bruises the eye but does not penetrate it, which can still cause substantial damage. Traumatic glaucoma secondary to blunt trauma is categorized as either early-onset or late-onset.

Early-onset types include:

• Trabecular meshwork disruption: The trabecular meshwork is your eye’s fluid-drainage system. It regulates your internal eye pressure, also known as intraocular pressure (IOP).
• Hyphema: Hyphema is the pooling of blood inside the anterior (front) chamber of the eye. It can partially or fully block the pupil and interfere with your vision. 
• Traumatic iritis: Blunt trauma can lead to inflammation of the iris or trabecular meshwork. It is usually reversible and responds effectively to anti-inflammatory agents, like steroids, or non-steroidal anti-inflammatory drugs (NSAIDs).
• Choroidal hemorrhage: This occurs when a blood vessel bursts in the choroid (a thin layer of tissue in the middle of the eye wall). It is also a cause of acute IOP increase in patients who are on anticoagulation drugs.

Late-onset types include:

• Angle recession glaucoma (ARG): This is a tear in the ciliary (smooth) muscles of the eye. It is thought to indicate more serious damage to the trabecular meshwork that can cause scarring.
• Hemolytic and/or ghost cell glaucoma: This is caused by rigid degenerated red blood cells (ghost cells) that block the trabecular meshwork. The condition is generally self-limiting. 
• Lens subluxation or dislocation: When the globe of the eye experiences trauma, the lens can be pushed out of place.
• Phacolytic glaucoma: This is when a mature cataract starts leaking proteins through an intact lens. It is usually treatable by removing the cataract with surgery.

How does glaucoma occur as a result of penetrating injury?

Penetrating injuries can lead to glaucoma by some of the same paths as blunt trauma, including: 

• Hyphema
• Lens dislocation
• Cataract leakage
• Presence of ghost cells 

Other paths include:

• Injury to the cornea 
• Adhesions that form at the back of the lens
• Injury to the lens itself, causing inflammation and/or blockage of the trabecular meshwork
• Bowing of the iris
• Epithelial cell migration through the wound, followed by cell proliferation

How is traumatic glaucoma diagnosed?

In order to inform and guide the physical examination examination, your doctor will ask for a detailed history that will help identify the:

• Nature (blunt vs. penetrating) of the injury
• Presence and nature of a foreign body (such as high speed projectiles, like shrapnel or glass)
• Timeline for developing increased IOP 
• Setting in which the injury occurred (i.e., school, work, etc.)
• Eye health history (like history of cataract or pre-existing glaucoma) 

The physical exam consists of a:

• Visual acuity assessment
• Visual inspection of the outer eye
• Examination of the inner eye with a bright light 
• Dilation of the eyes
• Gonioscopy (to examine the angle of injury and rule out a foreign object)
• Imaging (if a suspected foreign object might be hard matter, like glass or metal)

How is traumatic glaucoma treated?

The initial treatment approach to traumatic glaucoma is much the same as that to non-traumatic glaucoma, with the goal being to reduce IOP. Topical therapies such as eye drops are generally prescribed first, along with the management of underlying health issues. If those are insufficient, laser therapy and surgical procedures are considered as appropriate. The nature and form of the injury will dictate what type of surgery is necessary.  

*Mikhael, M., Khouri, A. S., & Murchison, A. (2019, Sep. 22). Traumatic Glaucoma. American Academy of Ophthalmology Eye Wiki. https://eyewiki.aao.org/Traumatic_Glaucoma

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