Aqueous Misdirection

Aqueous misdirection occurs as a result of increased vitreous volume due to misdirection of aqueous humor into the vitreous cavity, choroidal expansion, and/or difficulty in fluid egress from the vitreous. Patients with aqueous misdirection present with axial shallowing of the anterior chamber and normal to elevated intraocular pressure, most often after surgery or laser treatment for angle-closure glaucoma. Aqueous misdirection is a diagnosis of exclusion, and careful examination and/or imaging should exclude pupillary block, ciliochoroidal detachment, bleb leak and suprachoroidal hemorrhage. Initial treatment is medical (cycloplegia and pressure lowering) or laser-based (Nd: YAG anterior hyaloidotomy), though definitive resolution often requires pars plana vitrectomy. Visual loss is common after aqueous misdirection, and the fellow eye should be treated carefully as the condition can occur bilaterally.