University of Iowa Health Care

Ophthalmology and Visual Sciences

Iowa Glaucoma Curriculum

Supplementary Material


Chapter 50

Case from
Hypotony: Late hypotony from trabeculectomy and Ahmed seton with resulting hypotony maculopathy: A 36-year old female presented with poor vision secondary to a low intraocular pressure (IOP) in her right eye.


Cyclodialysis cases from

Cyclodialysis Cleft (1): This 43 year-old man was punched in this eye 5 years previously and has had decreased vision since that time. On initial examination he had 20/50 vision with an intraocular pressure of 8 mmHg. Gonioscopy was difficult but it appeared that there might be a cyclodialysis cleft inferiorly. The patient was treated with steroids in the hope of decreasing trabecular outflow. He was also placed on atropine to deepen the angle. On follow-up his intraocular pressure had not improved but the atropine had improved the view of his iridocorneal angle and it was clear that there was a cyclodialysis cleft at twelve o'clock.

Cyclodialysis Cleft (2): This 18 year-old woman was struck by a water balloon in her left eye. She presented with count fingers vision and an intraocular pressure of 4 mmHg. She had a 30% hyphema. After a period of hypotony her intraocular pressure gradually returned to a normal level without intervention. This video was taken five months after her injury and shows a cyclodialysis cleft that has healed on its own.

Cyclodialysis Cleft (3): This patient was struck in the eye with a bungee cord five months prior to this examination. He sustained a hyphema, which resolved. However two months later he had decreased visual acuity with optic nerve edema and retinal folds. On examination he had 20/300 vision in the right eye with an intraocular pressure of 7 mmHg.

Cyclodialysis Cleft (4): This patient was injured with a racquetball in the left eye 37 years before he was evaluated in our clinic. He did not have any examination at the time of injury. In 2012 he was found to have an elevated intraocular pressure with angle recession. On our examination we found the angle to be recessed with a very wide area of a cyclodialysis cleft that has clearly healed on its own.