Diagnostic dilemma: angle recession and traumatic glaucoma versus Posner-Schlossman syndrome

A man in his mid-40s initially presented with acute unilateral ocular pain, redness and elevated intraocular pressure (IOP 32 mm Hg) in the right eye. Clinical records at that time documented circumcorneal congestion and a significant anterior chamber reaction (cells 3+), with a normal cup-disc ratio, leading to a diagnosis of Posner-Schlossman syndrome. The patient's symptoms improved with topical steroids and three antiglaucoma medications; however, self-discontinuation led to intermittent IOP fluctuations. When evaluated 15 months after the initial episode, he had reduced vision (6/9), an IOP spike (34 mm Hg), an inferotemporal sphincter tear and advanced optic nerve cupping (0.8). Gonioscopy revealed inferotemporal angle recession, and retrospective history disclosed prior blunt trauma. This shifted the diagnosis to traumatic glaucoma secondary to angle recession, a condition with sustained structural and optic nerve damage-unlike the typically benign, transient course of Posner-Schlossman syndrome. Accurate differentiation is critical, as traumatic cases may require early surgical intervention, in contrast to the conservative management of Posner-Schlossman syndrome.