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'The pupillary snap': a new clinical sign in aqueous misdirection

Poster Details

First Author: T.Iqbal UK

Co Author(s):    A. Makuloluwa   V. Shankar                 

Abstract Details


The purpose of this study is to report a new clinical sign in aqueous misdirection that developed following cataract surgery. It highlights a clinical sign that hopes to be useful in the diagnosis and management of this elusive condition.


Royal Blackburn Teaching Hospital, Blackburn, England


An ophthalmologic examination including visual acuity, external exam, slit lamp exam, tonometry, indirect fundoscopy and gonioscopy was performed. Topical management as well as Nd:YAG capsulotomy and hyaloidotomy were also carried out.


A 55-year-old woman with a history of narrow angle glaucoma and bilateral YAG peripheral iridotomies presented with a shallow anterior chamber and rising intra-ocular pressure (IOP) to 64mmHg, which was subsequently refractive to medical management. This, in a pseudophakic eye, necessitated YAG capsulotomy and hyaloidotomy. Here, after two shots of single-burst YAG laser of 1.4mJ, sudden pupillary constriction and re-dilation or a 'pupillary snap' was observed before visualization of deepening of the anterior chamber with vitreous prolapsing into anterior chamber. Two hours following the procedure IOP had reduced to 16mmHg.


This case illustrates a new clinical sign that may be an overt manifestation of pressure release. Effective use of capsulotomy and hyaloidotomy can remove the immediate threat to sight, and allows time to plan for definitive correction. We postulate that the pupillary snap may be a good indicator of the point when the anatomical and physiological abnormality has been reversed.

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