University of Iowa Health Care

Ophthalmology and Visual Sciences

Iowa Glaucoma Curriculum

Supplementary Material


Chapter 19

Cases from
Aqueous Misdirection: 88-year-old hyperopic female presented with left eye pain rated 10/10 and associated blurred vision, headache, nausea, and vomiting.

Bilateral sequential aqueous misdirection: an overview of medical and surgical management: 50-year-old Caucasian woman was referred to the University of Iowa Glaucoma Service for evaluation of ocular hypertension and anatomically narrow angles in both eyes.


Malignant glaucoma cases from
Response to Atropine: This patient was referred 5 days after trabeculectomy with a shallow anterior chamber and an intraocular pressure of 20 mmHg. She responded to treatment with atropine alone.

Aqueous Misdirection (Slit Lamp Only): Elevated IOP since age 23. Underwent a trabeculectomy at age 24. At 5 months after surgery he had an IOP of 13 mmHg. At 8 months after surgery he noted decreased vision. His IOP was 21 mmHg. A large fluid pocket was seen on echography. His anterior chamber deepened with atropine.

Aqueous Misdirection (1): Presented at age 41 with angle closure. She had had an iridotomy and iridoplasty. Despite maximum medical therapy her IOP was 52 mmHg. Her early postoperative course was uneventful. Four months later she presented with blurred vision and pain. Her IOP was 24 mmHg.

Aqueous Misdirection (2): A 48-year-old man was hit with a bungee cord 23 years previously. He had undergone an anterior chamber wash-out for hyphema and subsequently had corneal transplants in 1980 and 1999. When we saw him in 2001 he had been having pain in this eye for 2.5 years. He was on two glaucoma medications. One can see this anterior chamber is completely flat and in fact his IOL is embedding into his cornea. His pressure was 80 mm of mercury (checked on the sclera).