This is the right eye of a 36 year-old man who had a past history of traumatic retinal detachment.

a. What does the picture show?

Two physical signs are shown here:

• A Molteno's tube in the anterior chamber.
• Inferior iridectomy.

He had a traumatic retinal detachment and a subluxated lens. The lens was removed by intracapsular method and the retinal detachment tamponaded with silicone oil. The eye is aphakic and therefore the inferior iridectomy.
He developed raised intraocular pressure which failed to respond to topical medication. This was caused by angle recession glaucoma and the Molteno's tube was inserted to relieve the pressure.

b. In what ways can blunt ocular trauma affect the intraocular pressure?

The intraocular pressure can be reduced or raised.

Reduced intraocular pressure (hypotony) resulted from:

• cyclodialysis cleft

Raised intraocular pressure may be caused by:

• traumatic iridocyclitis (may result from blockage of the trabecular meshwork from the inflammatory cells, trabeculitis, posterior synechiae causing iris bombe, anterior synechiae.)
• displaced lens (causing pupil block or phacolytic glaucoma)
• hyphaema
• angle recession glaucoma
• ghost cell glaucoma from vitreous haemorrhage