Diagnosis and treatment

Not all cases of hypotony are treatable in the same way, and the answer depends largely on what we are trying to achieve.

If the goal is to improve or restore vision, many forms of hypotony can be treated. Before recommending treatment, we will usually assess the visual potential of the eye and consider whether the likely benefits outweigh any risks. This may involve specialist investigations, such as imaging of the ciliary body, retinal assessment and, in some cases, electrodiagnostic testing.

In some patients, the eye may have very limited potential for visual recovery despite treatment. In these situations, treatment may instead focus on maintaining the shape and appearance of the eye, improving comfort and helping the eyelids function more normally. For example, supporting the eye and preventing it from becoming progressively smaller may help the eye look more natural and reduce problems associated with a sunken appearance or incomplete eyelid closure.

There are also situations where treatment may carry more risk, inconvenience or discomfort than potential benefit. In these cases, careful observation may be the most appropriate option.

Our specialist hypotony team will discuss your individual circumstances during your clinic visit and help you decide which approach is most appropriate for you.

Not necessarily. Some patients have what is known as numerical hypotony, where the measured eye pressure is low but the eye remains structurally healthy and vision is unaffected. This can occur naturally or following successful glaucoma treatment.

The decision to treat hypotony is not based on the pressure reading alone. We also consider your vision, the structure of the eye, whether the eye is changing shape over time, and your risk of developing complications. In some cases, careful observation is the most appropriate approach.

Yes. If low eye pressure persists, structural changes can develop within the eye that may permanently affect vision. Early assessment and treatment may help prevent or reduce lasting damage.

Some cases of acute hypotony resolve once the underlying cause is treated. Chronic hypotony is less likely to improve without intervention and often requires specialist assessment and ongoing monitoring.

Treatment for chronic hypotony is often a long-term process rather than a single procedure.

Many patients require repeated assessments and multiple treatments over a period of weeks or months. During the early stages of treatment, it is common for patients to attend clinic every 1–2 weeks so that we can monitor the eye closely and determine whether further treatment is needed.

The goal is not simply to increase the eye pressure temporarily, but to restore and maintain the structure of the eye, preserve vision where possible and achieve a stable long-term result. Once the eye has stabilised, follow-up appointments usually become less frequent.

Viscoelastic treatment can be very effective in selected patients, but it does not replace the need to treat the underlying cause of hypotony.

If there is a retinal detachment, retinal traction, an over-draining glaucoma operation or another surgically correctable problem, we will usually recommend treating that first. Once the underlying cause has been addressed, additional treatments may be used to help restore and maintain the structure of the eye.

The most appropriate treatment plan depends on the cause of the hypotony, the condition of the retina and ciliary body, and the visual potential of the eye.

Not all patients require surgery. Treatment depends on the cause of the low eye pressure and may include observation, medication, injections, procedures or surgical repair. Your specialist will discuss the most appropriate option after assessing your eye.

No. Historically, treatment options for chronic hypotony have been limited, particularly when the eye has lost the ability to produce sufficient fluid. However, recent research from Moorfields has demonstrated that meaningful improvements in eye structure, eye pressure and vision can be achieved in selected patients using intravitreal viscoelastic treatments.

Not necessarily. While untreated chronic hypotony can progress to severe visual loss and structural degeneration of the eye, modern treatments may help preserve both vision and the integrity of the eye in appropriate patients.

Yes. Silicone oil remains an important treatment option for some patients with chronic hypotony. It can help maintain the shape and structural integrity of the eye when long-standing low pressure has caused the eye to soften or shrink.

In addition to providing internal support, silicone oil may be beneficial in certain patients with reduced vision because it can provide a degree of optical magnification, which may improve functional vision. The amount of visual benefit varies depending on the underlying condition and the anatomy of the eye.

Silicone oil does not restore the eye's ability to produce fluid and is not suitable for every patient. Long-term use can also be associated with complications, including reduced visual clarity, cataract formation, glaucoma and corneal problems.

The Moorfields hypotony team will discuss whether silicone oil, viscoelastic treatment or an alternative treatment approach is most appropriate for your individual circumstances.

In addition to measuring eye pressure, your specialist may recommend:

• Optical coherence tomography (OCT) imaging.

• Retinal examination.

• Ultrasound assessment of the ciliary body.

• Ultrasound imaging of the eye.

• Electrodiagnostic testing to assess retinal function and visual potential.

• Measurement of axial length (the length of the eye).

These tests help determine the cause of the hypotony, monitor response to treatment and assess the likelihood of visual recovery.