HV Tran,¹ RM Vessani,¹ JM Liebmann,^1,2 R Ritch,^1,2
1Department of Ophthalmology, The New York Eye and Ear Infirmary, New York, NY, USA ²The New York Medical College, Valhalla, NY, USA

Cyclodialysis clefts result from disinsertion of the longitudinal ciliary muscle fibres, separating the ciliary body from the scleral spur and underlying sclera, allowing direct communication between the anterior chamber and ciliochoroidal space and unrestricted bulk flow of aqueous from the anterior chamber to the supraciliary space. Cyclodialysis may be caused accidentally by trauma, iatrogenically during intraocular surgery, or intentionally for the treatment of glaucoma. Although the diagnosis can often be made by gonioscopy, clefts may be difficult to detect in recently traumatised or operated eyes because of hazy media, hypotony, shallow anterior chamber, or abnormal anterior segment architecture. The anatomic location of the pathology relative to the other structures of the eye as well as the inherent limitations of the instrument utilised may also prevent direct visualisation. Accurate diagnosis is necessary for appropriate management of hypotony, particularly when associated with decreased vision (Table 1). When direct visualisation of the cleft is difficult or impossible, ultrasound biomicroscopy (UBM) is a valuable tool for identifying and localising the cleft.

Treatment directed at reversing the hypotony aims to either close the cleft or wall it off. We report a case of ocular hypotony secondary to a cyclodialysis cleft that was successfully managed with the aid of UBM and review the literature on diagnosis and management of cyclodialysis clefts.