Anterior Chamber Blunt Trauma

Aka: Anterior Chamber Blunt Trauma, Cyclodialysis Cleft, Iridodialysis

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II. Definitions

  1. Iridodialysis
    1. Traumatic separation of iris from ciliary body
    2. Risk of Aqueous Humor accumulation (blocked absorption) with Increased Intraocular Pressure
  2. Cyclodialysis Cleft
    1. Separation of ciliary Muscle fibers from attachment at Scleral spur
    2. Results when the globe is briefly compressed followed by rapid re-expansion
    3. Results in Ocular Hypotony (Intraocular Pressure <5 mm Hg)

III. Pathophysiology

  1. Cyclodialysis Cleft results in Aqueous Humor leak from anterior chamber into suprachoroidal space
  2. Presents with Ocular Hypotony (Intraocular Pressure <5 mm Hg)
  3. With prolonged hypotony, risk of Choroidal or Retinal Detachment, globe atrophy, permanent Vision Loss

IV. Evaluation

  1. See Blunt Eye Trauma
  2. Visual Acuity
  3. Slit Lamp Exam
  4. Intraocular Pressure
    1. Increased Intraocular Pressure
      1. See Increased Intraocular Pressure
      2. Iridodialysis
    2. Ocular Hypotony (Intraocular Pressure <5 mm Hg)
      1. See Ocular Hypotony for Differential Diagnosis
      2. Cyclodialysis Cleft
  5. Ophthalmology
    1. Gonioscopy
      1. Anterior chamber angle of eye evaluation on Slit Lamp
      2. Specialized Contact Lens typically used to help evaluate the anterior chamber angle
    2. Other measures
      1. Ultrasound Biomicroscopy
      2. Anterior Segment Optical Coherence Tomography
      3. Scleral Transilluminator

V. Management: Cyclodialysis Cleft

  1. Treatment indicated when Ocular Hypotony affects Ocular Function
  2. Start with conservative medical management (by Ophthalmology)
    1. Some episodes of cyclodialysis resolve spontaneously
    2. Short-term delay with conservative management does not appear to affect outcomes
    3. Topical Cycloplegic (Atropine) for 6-8 weeks
      1. Relaxes ciliary body allowing it to re-adhere to Sclera
    4. Topical Corticosteroids ()
      1. Promotes spontaneous cleft closure
  3. Surgical Management for failed conservative management (within 3 months of onset)
    1. Laser Photocoagulation
    2. Surgical Repair

VI. References

  1. Cramer, Berg and Geloneck (2021) Crit Dec Emerg Med 35(7):10-1

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