⚠️ Aqueous Misdirection After Glaucoma Surgery: What You Need to Know
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🟠 STORY AT A GLANCE
Aqueous misdirection (also known as malignant glaucoma) is a rare but serious complication that can occur after glaucoma surgery or other intraocular procedures.
It happens when aqueous fluid is misdirected into the vitreous cavity, causing shallowness of the anterior chamber and a dangerous rise in intraocular pressure (IOP).
Patients may experience eye pain, blurred vision, or even vision loss if not promptly treated.
This condition requires urgent diagnosis and management, which may include medications, laser therapy, or surgery.
Early intervention is critical to preserving vision and restoring normal eye pressure.
⚠️ Aqueous Misdirection After Glaucoma Surgery: What You Need to Know
Glaucoma surgery is often necessary to lower intraocular pressure and protect your vision—but in rare cases, things don’t go as expected. One of the most serious complications is aqueous misdirection, also known as malignant glaucoma.
This condition is not malignant in the cancer sense—but rather in how aggressively and dangerously it progresses. Left untreated, it can cause severe eye pressure spikes and irreversible damage.
👁️ What Is Aqueous Misdirection?
Under normal circumstances, aqueous humor (the clear fluid inside the eye) is produced by the ciliary body, flows through the posterior chamber, around the lens, through the pupil, into the anterior chamber, and then drains out of the eye.
In aqueous misdirection, this flow is disrupted. Instead of flowing forward into the anterior chamber, the fluid is misdirected posteriorly into the vitreous cavity, pushing the iris and lens forward, and making the front chamber of the eye shallow or flat.
This backward buildup increases pressure behind the lens and results in angle closure—even in eyes that have already had filtering surgery or lens removal.
🔍 What Causes It?
Aqueous misdirection is most commonly triggered by glaucoma surgery, especially:
Trabeculectomy
Glaucoma drainage implants (e.g., Ahmed or Baerveldt)
Laser iridotomy or capsulotomy
Pars plana vitrectomy (in some rare cases)
Risk factors include:
Small, crowded eyes (common in hyperopia)
Angle-closure glaucoma history
Prior intraocular inflammation or surgery
Use of miotics (e.g., pilocarpine) post-op
🧠 Symptoms You Should Watch For
Sudden blurry vision
Eye pain or pressure
Shallow or flat anterior chamber (you might notice a sudden change in how the eye feels)
Elevated intraocular pressure, even after filtering surgery
Sometimes corneal edema or light sensitivity
If you’ve recently had glaucoma surgery and experience these symptoms, you must contact your ophthalmologist immediately.