Eyeworld

72 | EYEWORLD | SUMMER 2026 G UCOMA by Liz Hillman Editorial Co-Director About the physicians Maria Charria, MD Dra. Charria Centro Oftalmológico Adjunct Professor Universidad de la Sabana Bogota, Colombia Won Kim, MD Eye Doctors of Washington Chevy Chase, Maryland I n the past, this section of EyeWorld has delved into nuanced glaucoma subtypes. In this issue, Won Kim, MD, and Maria Charria, MD, get into the specifics related to traumatic glaucoma. When does it occur? There are many scenarios that can result in traumatic glaucoma. Blunt trauma, Dr. Kim said, can cause hyphema, which increases the like- lihood of traumatic glaucoma, with the blood itself clogging the trabecular meshwork. "The more blood, the more risk. Also, sickle cell is an important risk factor. Blood in the vitreous can become 'ghost cells,' which could migrate into the anterior chamber and clog the trabecular meshwork, elevate IOP, and cause glaucoma," Dr. Kim said. The trauma can also cause inflammation, and treatment of inflammation with steroids can elevate IOP. Inflammation could cause peripher- al anterior synechiae and IOP elevation. Inflam- mation could cause posterior synechiae, which could lead to pupillary block angle closure and glaucoma. "Trauma could damage the zonules of the lens, with the lens dislocating anteriorly and causing pupillary block angle closure," he said. If trauma is from a chemical injury, glau- coma can result due to penetrability of some chemicals, Dr. Kim said. Other sources of trau- matic glaucoma are penetrating injuries with epithelial downgrowth leading to intractable glaucoma and metallic intraocular foreign bod- ies leading to siderosis, resulting in glaucoma. "There are many potential causes. Some- times glaucoma from trauma can arise years, even decades, later via angle recession glauco- ma," Dr. Kim said. Dr. Charria went over the two main sources of traumatic glaucoma: blunt injuries and open globe injuries. "If it's blunt trauma, the main risk factor you would see is angle recession, more than 180 degrees," she said, noting this would be visible on gonioscopic exam. "You would then know that this person has a risk of developing traumatic glaucoma over their lifespan." Dr. Charria said that for the most part, glaucoma due to trauma would develop after 6 months. "You have to assess your patient in the first 6 months and between 6 months and a year," taking pressures and visual fields, she said. This would give you time to observe any changes in the nerve or in pressure. "It's not necessarily going to be immediately after trauma or immediately after the acute part is resolved, but it's a late onset scenario." Even if traumatic glaucoma doesn't develop within 6 months, Dr. Charria said these patients are still not out of the woods. "They need to follow up every year for the rest of their lives because if they develop traumatic glaucoma in the affected eye, they have a 50% chance of developing it in the healthy eye, and no one knows why." It's not uncommon for Dr. Charria to see patients years after they've experienced trauma. "When I ask them, 'Did you have trauma in that eye?' they say, 'Yes, when I was a little boy' or something like that, and they may be 60 years old now and starting to develop glaucoma," she said. "So, a person has to be assessed at least once a year for traumatic glaucoma for the rest of their lives because even their healthy eye is at risk." When it comes to glaucoma resulting after an open globe injury, Dr. Charria said the dis- ease would show up sooner rather than later, and it depends on the extent of the open globe damage. Diagnosis and confirmed traumatic glaucoma In both open globe and blunt trauma situations, gonioscopy is a must, Dr. Charria said. If you Traumatic glaucoma: causes, timing, and management " … if they develop traumatic glaucoma in the affected eye, they have a 50% chance of developing it in the healthy eye, and no one knows why." —Maria Charria, MD

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