Transient myopia after trauma

Abstract

In their March 2002 article “Pathogenesis of Transient High Myopia after Blunt Eye Trauma” (Ophthalmology 2002:109:501–7), the authors describe 2 patients with transient myopia, shallowing of the anterior chamber with anterior shift of the lens-iris diaphragm, and thickening of the crystalline lens after blunt ocular trauma. The authors discuss several hypotheses to explain their findings and suggest as underlying cause a new disease entity they named “ciliochoroidal effusion syndrome.” We are surprised that the authors did not include traumatic cyclodialysis in their differential diagnostic considerations as the findings in the two presented patients appear very compatible with traumatic cyclodialysis, and as they even briefly mention the presence of cyclodialysis as diagnosed by ultrasound biomicroscopy in patient 2 in their paper. Traumatic cyclodialysis relates to disinsertion of an area of the ciliary muscle from its attachment at the scleral spur and is clinically diagnosed by gonioscopy and by ultrasound biomicoscopy. It frequently causes ocular hypotony, ciliochoroidal detachment, swelling of the optic nerve head, and cystoid macular edema with macular folds.1Chandler P.A. Maumenee A.E. A major cause of hypotony.Am J Ophthalmol. 1961; 52: 609-618Abstract Full Text PDF PubMed Scopus (76) Google Scholar, 2Küchle M. Naumann G.O.H. Direkte Zyklopexie bei Zyklodialyse mit persistierendem Hypotonie-Syndrom.Fortschr Ophthalmol. 1990; 87: 247-251PubMed Google Scholar, 3Ormerod L.D. Baerveldt G. Sunalp M.A. Riekhof F.T. Management of the hypotonous cyclodialysis cleft.Ophthalmology. 1991; 98: 1384-1393Abstract Full Text PDF PubMed Scopus (97) Google Scholar In a previous study in Ophthalmology, we have shown that cyclodialysis is frequently associated with a marked myopic refractive shift of up to 3.5 D in phakic eyes, and that this shift is reversible after successful surgical closure of the cyclodialysis cleft by direct cyclopexy.4Küchle M. Naumann G.O.H. Direct cyclopexy for traumatic cyclodialysis with persisting hypotony. Report in 29 consecutive patients.Ophthalmology. 1995; 102: 322-323Abstract Full Text PDF PubMed Scopus (115) Google Scholar Ocular hypototony usually persists in the majority of cases with traumatic cyclodialysis, nevertheless, cyclodialysis clefts may close spontaneously during the first days or weeks following trauma with normalization of intraocular pressure, especially if eyes are treated with cycloplegic drugs.3Ormerod L.D. Baerveldt G. Sunalp M.A. Riekhof F.T. Management of the hypotonous cyclodialysis cleft.Ophthalmology. 1991; 98: 1384-1393Abstract Full Text PDF PubMed Scopus (97) Google Scholar From the description of the authors, we believe that traumatic cyclodialysis should be right at the top of the list of differential diagnoses. We feel that traumatic cyclodialysis with possible subsequent spontaneous closure was present as the underlying cause for the clinical findings in patient 2 and possibly also in patient 1. We would like to stress the importance of a correct clinical diagnosis of traumatic hypotonous cyclodialysis. All patients following blunt eye trauma with a shallow anterior chamber and/or with ocular hypotony should undergo careful, and if necessary, repeated evaluation including gonioscopy and, if possible, ultrasound biomicroscopy to specifically rule out cyclodialysis. This is of utmost importance as cyclodialysis with persisting ocular hypotony is amenable to very successful surgical treatment by direct cyclopexy,2Küchle M. Naumann G.O.H. Direkte Zyklopexie bei Zyklodialyse mit persistierendem Hypotonie-Syndrom.Fortschr Ophthalmol. 1990; 87: 247-251PubMed Google Scholar, 4Küchle M. Naumann G.O.H. Direct cyclopexy for traumatic cyclodialysis with persisting hypotony. Report in 29 consecutive patients.Ophthalmology. 1995; 102: 322-323Abstract Full Text PDF PubMed Scopus (115) Google Scholar, 5Naumann G.O.H. Völcker H.E. Direkte Zyklopexie zur Behandlung des persistierenden Hypotonie-Syndroms infolge traumatischer Zyklodialyse.Klin Monatsbl Augenheilkd. 1981; 179: 266-270Crossref PubMed Scopus (25) Google Scholar, 6Naumann G.O.H. Küchle M. Noninvasive closure of persisting cyclodialysis cleft.Ophthalmology. 1997; 104: 1207Abstract Full Text PDF PubMed Scopus (5) Google Scholar, 7Kato T. Hayasaka S. Nagaki Y. Matsumoto M. Management of traumatic cyclodialysis cleft associated with ocular hypotony.Ophthalmic Surg Lasers. 1999; 30: 469-472PubMed Google Scholar thus preventing progressive damage of the anterior and posterior segment caused by long-standing ocular hypotony.1Chandler P.A. Maumenee A.E. A major cause of hypotony.Am J Ophthalmol. 1961; 52: 609-618Abstract Full Text PDF PubMed Scopus (76) Google Scholar