Management and Treatment of Angle Recession

Initial Assessment and Diagnosis

• Gonioscopic examination is essential to diagnose angle recession, which appears as a deepened angle recess or approach in the anterior chamber 2
• Evaluate the extent of peripheral anterior synechiae (PAS) formation using dark-room gonioscopy with compression/indentation 1
• Assess for trabecular damage which may have occurred during iridocorneal apposition 1
• Rule out other causes of secondary angle closure that may coexist with angle recession 2

Medical Management

• First-line treatment includes topical ocular hypotensive agents similar to those used for primary open-angle glaucoma 1
• Agents that suppress aqueous humor formation are typically used, including topical beta-adrenergic antagonists 3
• Agents that suppress aqueous humor formation are typically used, including topical alpha2-adrenergic agonists 3

Laser Therapy Options

• Laser peripheral iridotomy (LPI) is indicated if there is a component of pupillary block contributing to the angle closure 3

Surgical Management

• Goniosynechialysis may improve aqueous outflow if performed within 6-12 months of injury 1

Follow-up and Monitoring

• Regular follow-up evaluations should include IOP measurement 1
• Regular follow-up evaluations should include gonioscopy to assess for progression of PAS 4
• Regular follow-up evaluations should include optic nerve examination and visual field testing to monitor for glaucomatous damage 2