Acute Angle-Closure Glaucoma Secondary to Vitreous Prolapse Following Ocular Trauma

Secondary acute angle-closure glaucoma (AACG) caused by vitreous prolapse in a phakic patient is exceedingly rare. We report a case of AACG secondary to vitreous prolapse, occurring 2 weeks after orbital trauma in a 34-year-old male healthcare worker. The patient presented with acute left eye pain, nausea, and vision loss after performing cardiopulmonary resuscitation (CPR) at his workplace. Two weeks earlier, he sustained a nonoperative orbital floor fracture and commotio retinae from a motor vehicle accident. Examination revealed decreased vision and an intraocular pressure (IOP) of 59 mmHg. Vitreous prolapse into the anterior chamber was detected. Urgent anterior vitrectomy was performed, leading to normalization of IOP and visual acuity improvement to 20/50 at 2 months postoperatively. Valsalva maneuvers and repetitive head movements during CPR likely precipitated vitreous herniation through trauma-induced zonular loss. This case underscores the need to consider vitreous prolapse in the differential for acute angle closure, especially in patients with recent ocular trauma.