II. Definitions
- Iridodialysis
- Traumatic separation of iris from ciliary body
- Risk of Aqueous Humor accumulation (blocked absorption) with Increased Intraocular Pressure
- Cyclodialysis Cleft
- Separation of ciliary Muscle fibers from attachment at Scleral spur
- Results when the globe is briefly compressed followed by rapid re-expansion
- Results in Ocular Hypotony (Intraocular Pressure <5 mm Hg)
III. Pathophysiology
- Cyclodialysis Cleft results in Aqueous Humor leak from anterior chamber into suprachoroidal space
- Presents with Ocular Hypotony (Intraocular Pressure <5 mm Hg)
- With prolonged hypotony, risk of Choroidal or Retinal Detachment, globe atrophy, permanent Vision Loss
IV. Evaluation
- See Blunt Eye Trauma
- Visual Acuity
- Slit Lamp Exam
-
Intraocular Pressure
-
Increased Intraocular Pressure
- See Increased Intraocular Pressure
- Iridodialysis
-
Ocular Hypotony (Intraocular Pressure <5 mm Hg)
- See Ocular Hypotony for Differential Diagnosis
- Cyclodialysis Cleft
-
Increased Intraocular Pressure
- Ophthalmology
- Gonioscopy
- Anterior chamber angle of eye evaluation on Slit Lamp
- Specialized Contact Lens typically used to help evaluate the anterior chamber angle
- Other measures
- Ultrasound Biomicroscopy
- Anterior Segment Optical Coherence Tomography
- Scleral Transilluminator
- Gonioscopy
V. Management: Cyclodialysis Cleft
- Treatment indicated when Ocular Hypotony affects Ocular Function
- Start with conservative medical management (by Ophthalmology)
- Some episodes of cyclodialysis resolve spontaneously
- Short-term delay with conservative management does not appear to affect outcomes
- Topical Cycloplegic (Atropine) for 6-8 weeks
- Relaxes ciliary body allowing it to re-adhere to Sclera
- Topical Corticosteroids ()
- Promotes spontaneous cleft closure
- Surgical Management for failed conservative management (within 3 months of onset)
- Laser Photocoagulation
- Surgical Repair
VI. References
- Cramer, Berg and Geloneck (2021) Crit Dec Emerg Med 35(7):10-1