Traumatic Glaucoma
Chat Highlights
June 23, 2004

On Wednesday, June 23, 2004, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Traumatic Glaucoma."

Moderator:  Welcome, Dr. Rick. Tonight's topic is "Traumatic Glaucoma." 

Dr. Rick Wilson:  Good evening, all.

P:  Doctor, how does trauma to the eye cause glaucoma?

Dr. Rick Wilson:  Trauma injures the trabecular meshwork, the "drain" in the eye.  Scarring ensues, and the drain works less well. Early on, blood and inflammatory material can also block the trabecular meshwork.

P:  Is there a way to determine if an eye injury will lead to glaucoma? What do you look for at the time of the injury?

Dr. Rick Wilson:  Often there are signs of injury to the drain in the eye.  One sign is called an angle recession.  With this sign, the iris root is pulled posteriorly away from the trabecular meshwork. That is easily seen during gonioscopy.

P:  Does that also include a traumatic brain injury?  My eye was not hit, but I had two hematomas.  

Dr. Rick Wilson:  The eye can be injured without a brain injury, and the brain can be injured without an eye injury.  Most of the time, the eye has to be hit to cause significant injury to it. However, retinal hemorrhages and tears can be caused by sudden changes in head position or acceleration.

P:  Can the trabecular meshwork be repaired?

Dr. Rick Wilson:  Not with our present technology. 

P:  Does all traumatic glaucoma manifest itself at the time of trauma, or is it possible for it to cause glaucoma many years later?

P:  In my case, it was 28 years later.

Dr. Rick Wilson:  There is at least a 5% chance that someone with serious eye trauma and an angle recession will develop glaucoma later in life, even if the glaucoma is not present for several years after the trauma.  An article in the early Seventies described what happened to boxers in New York State after they quit boxing.  That's where the original estimation of later development of 5% came from.  

P:  What counsel do you give people with injured eyes regarding the possibility of getting glaucoma? When my eye was severely injured in 1972, no one mentioned that possibility.  Is that because it was less well understood then?

Dr. Rick Wilson:  The interesting fact is that patients who develop traumatic glaucoma in one eye frequently develop glaucoma in the fellow eye later in life, although that eye didn't suffer injury.  

P:  Why is that?

Dr. Rick Wilson:  It may be that the injury brought on glaucoma in someone who was susceptible to it much earlier than he or she would have developed it otherwise.  

P:  I was diagnosed with glaucoma  at an early age due to a scratched cornea.  They didn't say it was caused by trauma.  Can you always tell whether glaucoma was caused by trauma or if it has been present since birth? 

Dr. Rick Wilson:  Often the time course gives a clue, but not always.

P:  So, I may get glaucoma in my uninjured eye later in life.  Are there any types of food or health habits that can prevent glaucoma?  

Dr. Rick Wilson:  Exercise and maintaining a normal weight have been proven to be helpful.  Keeping a normal blood pressure has been suggested by at least one study.

P:  Can anything be done when treating an injured eye to prevent glaucoma later on?

Dr. Rick Wilson:  Inflammation should be controlled as quickly as possible.  If there has been a penetrating injury into the eye, that  needs to be closed and sealed meticulously.  If there is a leak through the wound, the anterior chamber will shallow and the iris will come up against the trabecular meshwork. Since the eye is inflamed, the iris will likely stick to the trabecular meshwork and result in glaucoma.

P:  Does traumatic glaucoma -- say, from a blow to the eye -- progress at the same rate and in the same manner, generally speaking, as POAG or any other glaucoma? 

Dr. Rick Wilson:  We don't definitely know the answer to that question.  If the intraocular pressure is raised to a similar degree, I would expect the nerve damage to progress at the same rate in both kinds of glaucoma.  Traumatic glaucomas often have higher intraocular pressure, so I would expect that type to progress at a faster rate.

P:  Do emergency rooms see an increase in eye injury related admissions in the summer months, or is it a year-round problem?

Dr. Rick Wilson:  That's a timely question.  In the U.S., the 4th of July celebrations result in a tsunami of fireworks-related eye injuries hitting emergency rooms.  

[Editor's note:  Balls, lawnmowers, bungee cords, water balloon, slingshots, BB guns, paint ball pellets, household cleaners, and car batteries are also all potentially dangerous to our eyes.]

End of highlights for June 23, 2004.

On June 30, Dr. Werner discussed "Young Glaucoma Patients" in the Chat room. Click here for highlights of that meeting.

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