Asymptomatic chronic hypotony due to subclinical choroidal effusion after blunt trauma

  • John Mark Sim de Leon East Avenue Medical Center
  • Ronald Steven Medalle East Avenue Medical Center
Keywords: blunt trauma, choroidal effusion, cyclopexy, hypotony, intraocular pressure, ultrasound biomicroscopy


Objective: To present a case report of asymptomatic post-traumatic chronic hypotony in which the cause was undetected until phacoemulsification.

Methodology: Case report.

Results: A 55-year-old female’s left eye suffered blunt trauma causing hyphema and iritis, which were successfully managed; however, up to a year after, the intraocular pressure (IOP) ranged from 3 to 5 mmHg and the anterior chamber remained very shallow (Van Herick grade 4) with the lens–iris diaphragm pushed anteriorly with difficulty assessing the angles for recession or clefts . Visual acuity was initially 20/20 upon resolution of the hyphema but worsened to 20/40 a year after, presumably due to a developing cataract. Periodic dilated fundus examinations revealed no hypotony maculopathy or choroidal effusions. Prior to phacoemulsification, ultrasound biomicroscopy (UBM) revealed 360 degrees of mild peripheral choroidal effusions. During phacoemulsification, after intraocular lens insertion, direct gonioscopy revealed a supero-nasal cyclodialysis cleft (2 clock hours) and this was repaired intraoperatively with direct cyclopexy through a partial thickness scleral flap. Postoperatively, the vision improved to 20/20 without correction and the IOP normalized to 16 to 18 mmHg.

Conclusion: Chronic hypotony post-trauma may be asymptomatic and the cause may not be clinically evident and may be detected by UBM (choroidal effusion). In our case, the proximate aetiology (cyclodialysis cleft) of the effusion was only observed intraoperatively after phacoemulsification for which cyclopexy was performed which increased the IOP to physiologic levels.

Author Biography

John Mark Sim de Leon, East Avenue Medical Center

Dr. John Mark de Leon has a special interest for visual fields and imaging in glaucoma. He is an avid educator and a heart for glaucoma research. He finished is medical education at the University of the Philippines and his residency in ophthalmology at the Cardinal Santos Medical Center. He completed glaucoma clinical research fellowships at the Massachusetts Eye and Ear Infirmary, Boston, the Singapore Eye Research Institute, and most recently at the Jules Stein Eye Institute, University of California, Los Angeles, where he was awarded the 2014 International Fellow Excellence in Research Award for his study “Differential Effects of the Fast and Slow Components of Visual Field Decay after Trabeculectomy”.  He is presently a board member of the Philippine Glaucoma Society and head of the committee of continuing medical education. He is affiliated with the Cardinal Santos Medical Center, St Luke’s Medical Center. and East Avenue Medical Center.


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How to Cite
de Leon, J. M., & Medalle, R. S. (2020). Asymptomatic chronic hypotony due to subclinical choroidal effusion after blunt trauma. Asian Journal of Ophthalmology, 17(2), 203-208.
Case Reports/Case Series