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Glaucoma / Anterior Chamber

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Anterior Chamber and Trabecular Meshwork

Glaucoma: Yanoff defines as “a syndrome characterized by an elevation of intraocular pressure of sufficient degree or chronicity to produce ocular tissue damage.” Quigley defines as “an optic neuropath associated with characteristic excavation of the optic disc and progressive loss of visual field sensitivity.”

The eye produces (at the ciliary body – nonpigmented ciliary epithelial cells) and drains aqueous fluid (at the trabecular meshwork and canal of Schlemm and to a lesser extent, iris veins and posterior uveoscleral outflow) constantly. The balance of these processes determines intraocular pressure.

Normal trabecular meshwork

11.01 Normal trabecular meshwork. Schwabes line is seen at the termination of descemets membrane. Also seen is the nonpigmented trabecular meshwork, the pigmented area, and the scleral spur.

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11.02 Normal trabecular meshwork

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11.03 High magnification view of schlems canal and juxtacanalicular tissue.

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11.04 Schlemms canal with a draining aqueous vein

Nick’s Tips: (no affiliation) is an excellent resource for additional information and clinical correlations.

Congenital Anomalies

Posterior embryotoxon: thickening and anterior displacement of Schwalbe’s line by thickening and balling of Descemet’s membrane.

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11.05 Thick Descemet’s in posterior embryotoxin

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11.06 Thick/folded Descemet’s in posterior embryotoxin

Axenfeld-Rieger Syndromes-Mesodermal dysgenesis. (Actually neural crest)

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11.07 Axenfeld-Rieger Syndrome looks like posterior embryotoxin with tissue extending onto the iris causing atrophy

Peter’s Anomaly

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11.08 Peter’s anomaly

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11.09 Peter’s anomaly – see posterior embryotoxin, fibers extending to the iris, and loss of central posterior cornea

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11.10 Peter’s anomaly – loss of central descemets and endothelium

Primary Congential Glaucoma

Nick’s Tips: Haab’s striae are horizontal and associated with glaucoma, Vogt’s striae are vertical and associated with keratoconus. Forceps injury also tends to cause vertical or oblique striae.

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11.11 Barkan’s “membrane” in congenital glaucoma is really an abnormal angle

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11.12 Maldeveloped angle in Barkan’s membrane

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11.13 Glaucomatous optic nerve

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11.14 Excavation at the optic nerve

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11.15 End stage glaucoma with thinning and loss of the ganglion cell layer of the retina


Iridocorneal Endothelial Syndrome (ICE)

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11.16 Essential iris atrophy

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11.17 Chandler syndrome

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11.18 Iris nevus (Cogan-Reese) syndrome

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11.19 Layer of abnormal endothelial cells growing over the angle onto the iris causing descemetization and holes in the iris

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11.20 Periphral iridectomy of an iris nevus

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11.21 Magnified iris nevus

Exfoliation syndrome (Pseudoexfoliation)

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11.22 Scalloped borders seen in exfoliation syndrome (pseudoexfoliation)

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11.23 Stained exfoliated material on the lens capsule appears similar to iron filings

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11.24 Exfoliative material clogging the trabecular meshwork

Phacolytic glaucoma

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11.25 Phacolytic glaucoma with injected conjunctiva and a mature cataract

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11.26 Macrophages engulf protein, clogging the meshwork in phacolytic glaucoma

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11.27 Aspirate of macrophages in phacolytic glaucoma


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11.28 Angle recession

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11.29 Angle recession compared to normal

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11.30 Long term sclerotic changes after angle recession

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11.31 Long term results of trauma causing angle recession and lens rupture

Pigment Dispersion Syndrome

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11.32 Radial transillumination

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11.33 Pigment dispersion syndrome with deposition in the meshwork and surface of the cornea

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11.34 Secondary open angle glaucoma due to the pigmented cells of uveal melanoma

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11.35 Secondary open angle glaucoma caused by malignant melanoma growing from ciliary body into iris root

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11.36 Optic nerve cross section of Schnabel’s optic neuropathy

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11.37 Alcian blue staining of hyaluronic acid in Schnabel’s

Glaukomflecken- vacated spaces under lens capsule after acute rises in IOP.

Nick’s Tips: look for history of high IOP and degenerating epithelium and cortical fibers.

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11.38 Swollen vacuolated spaces under lens epithelial cells in glaukomflecken


  1. Lewis, CJ, Hedberg-Buenz A, DeLuca AP, Stone EM, Alward WLM, Fingert JH. Primary congenital and developmental glaucomas. Hum Mol Genet 2017;26(R1):R28-R36.
  2. Abu-Amero KK, Edward DP. Primary Congenital Glaucoma. Gene Reviews 2017.
  3. Perry LP, Jakobiec FA, Zakka FR, Walton DS. Newborn primary congenital glaucoma: Histopathologic features of the anterior chamber filtration angle. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2012;16(6):565-568.