Acute inflammation of the ciliary body may cause aqueous hyposecretion and low IOP. This reduction in IOP is reversible with control of intraocular inflammation. In contrast, chronic inflammation may lead to ciliary body damage and atrophy of the ciliary processes, resulting in permanent hypotony. Hypotony may result in hypotony maculopathy, vision loss, and/or phthisis. Serous choroidal detachment often accompanies hypotony and complicates management. Prolonged choroidal effusions may require surgical drainage. Chronic hypotony can be treated with long-term local steroid administration in some cases. Surgery is indicated if there is ciliary body traction from a cyclitic membrane that can be released and if the ciliary processes are preserved (as shown on UBM). If ciliary processes are atrophic, vitrectomy with intraocular silicone oil or viscoelastic may help maintain ocular anatomy and increase IOP. In some of these cases, vision improvement after surgery can be significant; these gains may, however, be transient.
Daniel E, Pistilli M, Kothari S, et al; Systemic Immunosuppressive Therapy for Eye Diseases Research Group. Risk of ocular hypertension in adults with noninfectious uveitis. Ophthalmology. 2017;124(8):1196–1208.
Kapur R, Birnbaum AD, Goldstein DA, et al. Treating uveitis-associated hypotony with pars plana vitrectomy and silicone oil injection. Retina. 2010;30(1):140–145.
Sen HN, Drye LT, Goldstein DA, et al; Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group. Hypotony in patients with uveitis: The Multicenter Uveitis Steroid Treatment (MUST) Trial. Ocul Immunol Inflamm. 2012;20(2):104–112.
Excerpted from BCSC 2020-2021 series: Section 9 - Uveitis and Ocular Inflammation. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.