Hypotonous maculopathy and normal visual acuity secondary to post-traumatic cyclodialysis cleft

Post-traumatic cyclodialysis clefts commonly lead to profound visual loss secondary to hypotonous maculopathy. Current literature regarding cyclodialysis clefts definitively outlines the management of visual loss resulting from hypotonous maculopathy. Because hypotonous maculopathy with normal visual acuity is rarely reported, management is less well defined. Management guidelines for individuals with and without visual loss secondary to hypotonous maculopathy are reviewed.

A 32-year-old man came to us with symptoms of blur and glare in his left eye following airbag trauma two-and-a-half years earlier Best-corrected visual acuities measured 20/15 O.D. and O.S. A small iris sphincter tear was noted inferiorly and gonioscopic evaluation revealed a corresponding cyclodialysis cleft O.S. Intraocular pressures measured 10 mmHg O.D. and 2 mmHg O.S. Funduscopic evaluation of the left eye reveal optic disk edema, chorioretinal folds within the papillomacular bundle, venous tortuosity, and peripheral hemorrhages. Anticholinergic therapeutic management for hypotony was unsuccessful. Surgical intervention was not recommended. Visual function remains unchanged.

Identification of a cyclodialysis cleft is imperative after blunt trauma. Therapeutic and/or surgical intervention remains the treatment of choice when hypotonous maculopathy affects visual outcome. Conservative management may be indicated in those cases in which visual function is not impaired.