By Romesh I Angunawela MBBS; Usman Sarodia FRCOphth; Alan Lacey BS; Keith Barton MD

    Hypotony after trabeculectomy surgery, particularly with concurrent antimetabolite use, is relatively common. Hypotony occurs because of insufficient resistance to aqueous outflow at the scleral level. It can present soon after surgery or may be delayed in onset. Untreated, hypotony can lead to irreversible visual loss. The management of hypotony varies with clinical presentation, potential risk of complications, and time of onset. Here we discuss the presentation, mechanisms, and management options for hypotony after trabeculectomy surgery. This is illustrated throughout with high-quality video and animation.