Ocular hypotony is a condition of the eyes, in which the intraocular pressure (IOP), i.e. the fluid pressure inside the eye, drops to a level of 5 mm Hg or less. It is usually an indication of an underlying eye disorder. The two most common causes of this condition are fluid leakage and eyeball deflation.
Apart from the discomfort associated with hypotony, it can also lead to various other pathophysiological complications, which become more pronounced as the IOP approaches 0 mm Hg. These include maculopathy, corneal decompensation (accumulation of fluid in the cornea), and cataract formation.
The underlying cause of ocular hypotony is either the decreased formation, or the increased outflow of aqueous humor, which is the gelatinous fluid contained in the space between the lens and the cornea, and is responsible for maintaining IOP. The causes for decreased IOP include:
- Conditions causing increased outflow- wound leak, cyclodialysis cleft, overfiltering belb, etc.
- Conditions causing impaired ciliary body function- hypoperfusion, iridocyclitis, tractional ciliary body detachment etc. These conditions result in the decreased production of aqueous humor.
- Retinal detachment
- Altered osmotic state, causing greater outflow- This can be caused by the use of hyperosmotic agents e.g. glycerol, mannitol, urea, isosorbide etc.
- Inflammation, resulting in increased permeability of blood-aqueous barrier, and hence decreased aqueous humor production.
- Uncontrolled diabetes
- Uremia (High level of nitrogen waste in the body)
- Rupture of the sclera with a needle, suture or trauma
- Aqueous humor suppression by certain drugs- e.g., topical beta-blockers or carbonic anhydrase inhibitors.
Patients might report symptoms like blurred vision and deep pain in the eyes, or might be completely asymptomatic. Others might develop symptoms related to retinal detachment like floaters in the field of vision, “sparks of light” visible on moving the eyes, darkness in a particular region in the field of vision, etc.
The primary focus in the treatment of hypotony is usually focused on the underlying disorder that causes it. However, the following lines of treatment are followed to offer temporary relief:
- Inflation of the anterior chamber with gas or viscoelastic.
- Administration of steroids to enhance aqueous humor production.
- Increased fluid intake
- Patients who have had a recent inflammatory condition, or those who have undergone surgery or trauma are administered with topical prednisolone acetate, which helps in wound-healing.
- Atropine and other cycloplegics can be administered to restore lens anatomy.
- Most of the underlying disorders that cause hypotony might need surgical correction.
To know more about Ocular Hypotony and its treatment, visit us at Killeen Eyecare Center 416, North Gray Street, Killeen, TX 76541, and Downtown Killeen or call us at 254-634-7805.
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