Cyclodialysis: Causes, Symptoms, Diagnosis, Treatment

Cyclodialysis is a focal detachment of the ciliary body from its attachment to the scleral spur. Cyclodialysis develops after a dull or penetrating injury or as a complication after intraocular surgery, resulting in temporary or permanent hypotension.

[1], [2]

Epidemiology of cyclodialysis

Cyclodialysis develops after a blunt or penetrating injury, occurs less frequently in a recession angle. In every case of hypotension combined with a history of trauma, cyclodialysis should be suspected.

[3], [4], [5], [6], [7], [8], [9]

Pathophysiology of cyclodialysis

As a result of injury, the ciliary body separates from the place of its attachment to the scleral spur, leading to a direct exit of the intraocular fluid from the anterior chamber into the suprachoroidal space. As a result, hypotension develops. Spontaneous or induced closure of cyclodialysis causes an increase in intraocular pressure, as the main pathway of outflow of aqueous humor is destroyed.

Symptoms of cyclodialysis

In the history of patients, an episode of trauma or intraocular surgery. The disease is characterized by the absence of symptoms or decreased vision. When examining the affected eye, hypotension or increased intraocular pressure, pain, photophobia and redness are detected due to spontaneous closure of cyclodialysis.

Diagnosis of cyclodialysis

Biomicroscopy

When examining with a slit lamp, signs of a previous blunt or penetrating injury are determined, for example, scars on the cornea, staining it with blood, cataracts, rupture of the zonular ligaments supporting the lens (fakodenez), rupture of the sphincter of the iris or rupture in the area of its root (iridodialysis). In addition, it is possible to detect the signs of a previous intraocular surgery, for example, the posterior or anterior intraocular lens. Unlike healthy, the affected eye can be hypotonic, with corneal folds and a shallow anterior chamber.

Gonioscopy

Gonioscopy reveals a deep recession of the angle with a failure between the sclera and the ciliary body. This distinguishes cyclodialysis from a recession angle, which looks like an uneven, widened ciliary band. Recession of the angle can also develop after trauma to the damaged eye.

Rear Pole

Hypotension can lead to an acute detachment of choroid and the appearance of choroidal folds. When choroidal folds are involved in the macula, the condition is called hypotonic maculopathy. There may be signs of a previous trauma, for example, choroidal gaps, a posterior vitreous detachment or a macular rupture.

Special tests

Ultrasound B-scan should be performed with hypotension of the traumatized eye, with limited possibilities for examining the posterior pole, to exclude a latent rupture of the sclera or retinal detachment.

[10], [11], [12]

Treatment of cyclodialysis

The use of atropine sometimes leads to the closure of the cyclodialysis gap. In most cases, cyclodialysis with persistent hypotension requires surgical closure, but it is possible to use argon laser and cryotherapy. After that, intraocular pressure is often increased, and careful monitoring is necessary. If necessary, prescribe medication with hyperosmotic drugs and products that suppress the production of aqueous humor.