OcuLearning › Trauma

Iridodialysis and Cyclodialysis

URGENT — Trauma

Symptoms

usually asymptomatic early (unless hyphema present)

large iridodialysis: monocular diplopia, debilitating glare, and photophobia

blurred vision if hypotony maculopathy develops from a cleft

history of blunt or penetrating ocular trauma

Clinical Findings

Iridodialysis (iris disinsertion)

  • tearing of the iris root from the ciliary body
  • d-shaped or crescentic pupil with a dark peripheral gap
  • posterior lens surface or zonules may be visible through the gap

Cyclodialysis (ciliary body disinsertion)

  • tearing of the ciliary body from the scleral spur
  • creates a direct communication between the anterior chamber and suprachoroidal space
  • hallmark: profound ocular hypotony (iop often <5 mmhg)
  • clefts are often subtle; detected via gonioscopy or ubm/as-oct

Associated traumatic signs

  • hyphema and angle recession
  • iridodonesis or phacodonesis (from lens subluxation)
  • hypotony maculopathy: chorioretinal folds and optic disc edema

Etiology

Mechanism

  • blunt trauma: anteroposterior compression leads to equatorial expansion, shearing tissues at their thinnest points (iris root/scleral spur)
  • iatrogenic: complications during phacoemulsification or vitreoretinal surgery

Physiology

  • cleft leads to massive uveoscleral outflow (hypotony)
  • dialysis creates a functional "second pupil" (polycoria)

Red Flags

persistent hypotony (iop <5) following trauma: suspect a hidden cyclodialysis cleft

monocular diplopia: occurs when the iris gap allows a second image to reach the retina

sudden iop spike following cleft closure (pressure "rebound")

angle recession >180°: significant long-term risk for traumatic glaucoma

Investigations

Clinical diagnostics

  • slit-lamp exam: document pupil shape and peripheral gaps
  • gonioscopy (mandatory): identify the cleft and quantify angle recession
  • tonometry: monitor for profound hypotony or delayed hypertension

Imaging & posterior segment

  • ubm or as-oct: if gonioscopy is inconclusive or corneal edema is present
  • dilated fundus exam: rule out retinal dialysis, commotio retinae, and choroidal rupture

Treatment

Iridodialysis

  • conservative: tinted contact lenses or sunglasses for glare/diplopia
  • surgical: iris suturing (mccannel or siepser technique) for large, symptomatic defects

Cyclodialysis cleft

  • medical: atropine 1% and topical steroids to encourage cleft closure
  • procedural: argon laser photocoagulation, cryotherapy, or surgical pucker/cleft closure

Associated glaucoma

  • aqueous suppressants for iop elevation due to angle recession

Clinical Pearl

Unexplained hypotony after blunt trauma is a cyclodialysis cleft until proven otherwise — gonioscopy is the test that finds it, and closure restores IOP and vision.

Differential Diagnosis

  • iris coloboma (congenital)
  • iridoschisis (age-related stromal splitting)
  • iatrogenic iridectomy
  • post-traumatic angle recession without cleft

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