Supplementary Material

Chapter 26

Angle recession cases from
Angle Recession (Deep): 38 year-old man was struck in this eye two weeks ago with a rock thrown by a lawn mower. His lens was dislocated. His intraocular pressure was normal.

Angle Recession Dark CB Band: 44 year-old man who was involved in a motor vehicle accident as a child. He has mildly elevated IOPs and extensive angle recession in both eyes.

Angle Recession Broken Iris Process: 25 year-old man who has been a boxer for many years. He has had elevated IOP since age 22. His angles are recessed OU.

Pigment Dispersion from Angle Recession: This is a 67 year old male who has elevated intraocular pressures in both eyes, the right greater than the left. At age 13 he had severe blunt trauma to the right eye and had a very slow recovery and then a gradual decline again during his childhood. He had been treated for elevated intraocular pressure for over 20 years at the time these videos were taken. The patient has extensive angle recession and has a secondary pigment dispersion syndrome in the right eye. While his axial eye lengths are symmetrical his anterior chamber depth on the right side is deeper than the left (3.52 mm OD and 2.30 mm OS). This patient has been published: McKinney, J. K. and W. L. Alward (1997). "Unilateral pigment dispersion and glaucoma caused by angle recession." Arch Ophthalmol 115(11): 1478-9. Asymmetric pigmentary glaucoma caused by unilateral angle recession: Ritch, R. and W. L. Alward (1993). "Asymmetric pigmentary glaucoma caused by unilateral angle recession." Am J Ophthalmol 116(6): 765-6. NOTE: This clip is presented both under angle recession and under pigmentary.

Tangential Tear: This 32 year old gentleman was hit above the right eye with a golf ball from approximately 100 yards. He developed a hyphema. Subsequently he had an elevated intraocular pressure treated with beta blockers. On gonioscopy he was found to have extensive angle recession and an unusual tear visible in the ciliary body face.

Angle Recession with Sphincter Tear: Examples of angle recession emphasizing the need to compare the angles in the two eyes. 
Courtesy of: Howard Cohn, MD, American Hospital of Paris

Angle Recession with Iridodialysis: This young patient was hit with a BB pellet in a glancing blow that did not penetrate the eye or orbit. He presented with a count fingers vision and an intraocular pressure of 9 mmHg. He has an iridodialysis with angle recession. There is an area at 7 o’clock that looks like a cyclodialysis cleft. This patient’s low pressure resolved spontaneously and his vision returned to normal.

Angle Recession with Pigment Dispersion: 39 year-old man suffered severe head trauma six years before (he was in a motorcycle accident and hit a tree with his face). The right optic nerve is avulsed and the eye has no light perception. The left eye has 20/15 vision with mild ocular hypertension controlled on one medication. Both angles are recessed. The right has a flap tear in the ciliary body face and the left has pigment dispersion syndrome.

Angle Recession with Synechia: This 23 year old man was struck in the right eye with a plastic pellet fired from a C02 rifle. He presented with corneal edema, a 10% hyphema, and a pressure of 4 mmHg. At 6 weeks following the injury this video was taken. At that time his vision was 20/20 and his intraocular pressure 13 mmHg. He has a recession for about 180 degrees and also has areas where the iris is adherent across the recession.

Hyphema cases from

Hyphema (slit lamp only): This 15 year-old African-American male is had undergone fine needle aspiration for a lesion that was ultimately determined to be an adenoma of the non-pigmented epithelium of the ciliary body (see his pre-hemorrhage clip under the "Tumor" clips). The patient family denied a sickle cell history but later admitted that the patients uncle died from sickle cell disease. The patient bled at the time of surgery and developed a large hyphema requiring anterior chamber washout and trabeculectomy.

Corneal Blood Staining (slit lamp only) - 1: This 18 year-old man has had diabetes mellitus since age 4. He has had severe proliferative diabetic retinopathy and neovascular glaucoma for which he has undergone setons in both eyes. At the time of this video his intraocular pressure was 4 mmHg in this eye that has had no light perception for many months. This eye has had a long-standing hyphema of more than 6 months duration.

Corneal Blood Staining (slit lamp only) - 2: At age 37 this man was poked with a finger in the eye and had a 100% hyphema. During his management he had intraocular pressures as high as 60 mmHg. He was first seen in our clinic 6-months after the injury with an intraocular pressure of 20 mmHg and the corneal blood staining that can be seen clearly in this video. He ultimately required corneal transplantation because after 13 months this staining had not resolved.

Corneal Blood Staining -1: This 11 year-old was struck by a twig in the right eye. He had a partial thickness corneal laceration and a 1.8 mm hyphema with an intraocular pressure of 18 mmHg and 20/250 vision. Four days later he developed the flu with violent vomiting. When he was seen he had light perception vision with a 100% hyphema. He underwent anterior chamber washout with a trabeculectomy. This was repeated with an iridectomy a week later. Ten days after his severe rebleed he was noted to have corneal blood staining. The video follows the course of the resolution of his blood staining over the course of 14 months. He eventually underwent cataract extraction with IOL placement and had 20/25 vision.

Corneal Blood Staining - 2: This clip is an abbreviated version of the preceding clip. It shows the resolution of corneal blood staining over 14 months.

Ghost cell case from
Ghost Cells

Miscellaneous trauma cases from

Vossius Ring - slit lamp only: This is a 15 year-old male who was hit in the eye with a football kicked from about 8 feet away. He presented with a hyphema and a visual acuity of hand motion. This video was taken 6 days after the injury and shows Vossius ring.

Iridodialysis - Huge - slit lamp only: 47 year-old struck by rock in OD. Presented with CF vision and an IOP of 27 mmHg. His lens was dislocated. His IOP remained elevated despite maximum medical therapy and he underwent a pars plana vitrectomy, lensectomy and McCannel sutures x 6. The second video is nine years later. The IOP was 12 mmHg on three medications and the visual acuity with a contact lens was 20/20-3.

Metallic FB in CB: 50 years before this video was shot this 70-year old patient was grinding high quality steel and felt something strike his left eye. He was not examined at that point and had been doing well for many years. He developed glaucoma in both eyes, which was more difficult to control in this left eye. Suddenly, 50 years after his injury he developed a peaked pupil. He was found to have metal in his ciliary body.

Iridodialysis - Slit lamp only: This patient was in a car that struck a deer. The left eye had count fingers visual acuity in the large iridodialysis seen here. The pressure was 4 mmHg and the lens was dislocated into the vitreous. The patient underwent a pars plana vitrectomy and McCannel sutures (times four). Ultimately an aniridic style intraocular lens was placed but the patient’s vision never improved over 20/400 due to retinal pathology.