Cyclodialysis: causes, symptoms, diagnosis, treatment

Cyclodialysis is a focal detachment of the ciliary body from its attachment to the scleral spur. Cyclodialysis occurs after blunt or penetrating trauma or as a complication of intraocular surgery, resulting in temporary or permanent hypotony.

[ 1 ], [ 2 ]

Epidemiology of cyclodialysis

Cyclodialysis develops after blunt or penetrating trauma, and is less common than angle recession. Cyclodialysis should be suspected in any case of hypotension combined with a history of trauma.

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

Pathophysiology of cyclodialysis

As a result of the injury, the ciliary body is separated from its attachment to the scleral spur, causing direct leakage of aqueous humor from the anterior chamber into the suprachoroidal space. Hypotension eventually develops. Spontaneous or induced closure of the cyclodialysis causes an increase in intraocular pressure, since the main pathway for aqueous humor outflow is disrupted.

Symptoms of Cyclodialysis

Patients have a history of trauma or intraocular surgery. The disease is characterized by asymptomatic or decreased vision. Examination of the affected eye reveals hypotony or increased intraocular pressure, pain, photophobia, and redness due to spontaneous closure of the cyclodialysis.

Diagnosis of cyclodialysis

Biomicroscopy

Slit-lamp examination reveals signs of previous blunt or penetrating trauma, such as corneal scarring, blood staining, cataracts, rupture of the zonular ligaments that support the lens (phacodenesis), rupture of the iris sphincter, or ruptures at the root of the lens (iridodialysis). In addition, signs of previous intraocular surgery, such as a posterior or anterior intraocular lens, may be detected. Unlike the healthy eye, the affected eye may be hypotonic, with corneal folds and a shallow anterior chamber.

Gonioscopy

Gonioscopy reveals a deep angle recession with a depression between the sclera and the ciliary body. This distinguishes cyclodialysis from angle recession, which appears as an irregular, widened band of the ciliary body. Angle recession can also develop after trauma to the affected eye.

Posterior pole

Hypotony can lead to acute choroidal detachment and choroidal folds. When choroidal folds are involved in the macula, the condition is called hypotonic maculopathy. There may be evidence of prior trauma, such as choroidal tears, posterior vitreous detachment, or macular hole.

Special tests

Ultrasound B-scanning should be performed in cases of hypotony of the injured eye, with limited possibilities of examination of the posterior pole, to exclude hidden rupture of the sclera or retinal detachment.

[ 10 ], [ 11 ], [ 12 ]

Cyclodialysis treatment

Atropine sometimes closes the cyclodialysis gap. In most cases of cyclodialysis with persistent hypotension, surgical closure is necessary, but argon laser and cryotherapy can be used. After this, intraocular pressure is often elevated and must be carefully monitored. If necessary, drug therapy with hyperosmotic drugs and agents that suppress aqueous humor production is prescribed.