Ocular Hypotony Follow-up

Updated: May 06, 2016
  • Author: Sheila P Sanders, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Follow-up

Further Outpatient Care

Patients with ocular hypotony should receive vigilant follow-up care until the hypotony and the underlying cause have been stabilized.

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Deterrence/Prevention

Hypotony following glaucoma surgery can be prevented in several ways.

Minimally invasive glaucoma procedures such as canaloplasty, trabectome or ExPRESS shunt carry a lower risk of hypotony than traditional trabeculectomy or tube shunt surgery.

Consider lowering the exposure time and the concentration of antimetabolites, if used.

Using releasable sutures or placing extra sutures (which can be removed with laser suture lysis) in the trabeculectomy flap may prevent overfiltration.

For tube shunts, choosing a valved device or modifying the shunt with suturing techniques can slow drainage.

Many glaucoma surgeons leave the anterior chamber inflated with viscoelastic at the end of each case.

Aggressive use of anti-inflammatory agents can help prevent the cycle of iridocyclitis and hypotony.

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Complications

Corneal decompensation, synechiae, cataract formation, and chronic retinal edema or folds may occur. Hypotony maculopathy can cause permanent retinal pigment epithelium (RPE) disruption.

If suprachoroidal hemorrhage develops, the results are often catastrophic for the eye.

Prolonged hypotony may lead to prephthisis or phthisis bulbi.

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Prognosis

Prognosis varies with the cause and the extent of hypotony.

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Patient Education

Patients should be educated about the cause and the implications of this condition. Better understanding may help the patient to be more compliant with treatment and follow-up care. Patients should also be warned of the potential chronicity of hypotony. Improvement in visual acuity often lags behind the resolution of hypotony.

Emphasize activity limitations, use of eye shield, compliance with medications, and increased fluid intake.

Encourage patients to contact their provider if their situation seems to be worsening.

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