Hypotony maculopathy after eyelid massage for overcorrected blepharoptosis

A 57-year-old woman with a history of left eye trabeculectomy was evaluated for gradual ipsilateral visual loss. Several months prior, she had undergone levator advancement of the left upper eyelid. For management of resulting retraction, she was instructed to "massage" her eyelid. Examination was notable for left eye visual acuity of 20/200 and an intraocular pressure of 5 mm Hg. On fundoscopic examination, the macula was edematous with multiple folds, consistent with hypotony maculopathy. Two years later, after obliteration of the bleb and placement of a Seton valve, the intraocular pressure has increased to 8 mm Hg with an acuity correctable to 20/50. Ocular hypotony may result from digital eyelid massage in patients with filtering blebs. Clinicians should bear this in mind when managing patients with eyelid retraction after blepharoptosis repair.