Hypotony in One Eye: Understanding Low Intraocular Pressure and Its Consequences

By SWA

Hypotony, or low intraocular pressure (IOP), in one eye—particularly the left eye—can be a concerning condition. While the term may sound harmless, the consequences of prolonged or severe hypotony can be serious, potentially leading to vision loss or irreversible eye damage if not promptly addressed.

What Is Hypotony?

Hypotony refers to abnormally low pressure inside the eye. It is typically defined as an IOP of 5 mm Hg or less, although some people may not exhibit symptoms until the IOP drops below 6.5 mm Hg. For reference, normal IOP ranges between 12 and 22 mm Hg.

The Role of Aqueous Humor

The aqueous humor is the clear fluid produced by the ciliary body of the eye. It flows through the anterior and posterior chambers, nourishing the eye tissues and helping maintain proper pressure. A healthy eye maintains a balance between the amount of fluid produced and the amount drained.

If this balance is disrupted—by over-drainage or underproduction—the IOP drops, potentially leading to hypotony.

What Happens If Aqueous Humor Drainage Is Blocked?

While hypotony results from too little pressure, conditions like open-angle glaucoma (OAG) involve too much pressure due to blocked drainage. In OAG, the aqueous humor cannot drain properly, causing fluid buildup and elevated IOP. In contrast, hypotony often occurs when the fluid drains too freely or is not produced adequately.

Causes of Hypotony

Several underlying conditions or factors can lead to hypotony in one eye:

1. Post-Surgical Complications

Eye surgeries—especially glaucoma procedures like trabeculectomy—can sometimes lead to hypotony. If the surgical site leaks, it can result in excess fluid loss, dramatically reducing IOP.

2. Inflammation

Conditions such as uveitis can inflame and damage the ciliary body, which reduces aqueous humor production and leads to hypotony.

3. Retinal Detachment

A detached retina can disrupt the normal fluid dynamics of the eye, contributing to low IOP.

4. Other Causes

  • Scleral rupture (trauma-related)

  • Cyclodialysis cleft (a tear between the ciliary body and the sclera)

  • Medications, including some topical or systemic drugs that suppress aqueous humor production

Symptoms of Hypotony

The most noticeable symptom of hypotony is visual disturbance, including:

  • Blurred vision

  • Distorted vision

  • Severe vision loss (in advanced cases)

Other possible symptoms:

  • Eye pain

  • Redness

  • A sensation of pressure or discomfort in the affected eye

Treatment of Hypotony

Treating hypotony involves identifying and addressing the underlying cause.

1. Surgical Wound Leaks

If the issue is a post-operative leak, interventions may include:

  • Bandage contact lenses

  • Surgical suturing

  • Sealants or glues

2. Inflammation

For inflammation-related hypotony:

  • Corticosteroids or other anti-inflammatory medications may be prescribed to calm the eye and restore fluid production.

3. Retinal Issues

If a detached retina or cyclodialysis cleft is involved, surgical repair may be necessary.

4. Advanced Treatments

Depending on the severity, other interventions include:

  • Argon laser photocoagulation

  • Cryotherapy

  • Vitrectomy with endotamponade

How to Increase Aqueous Humor Production

Only a few medications are known to increase aqueous humor production:

  • Ibopamine

  • Pilocarpine

  • Bimatoprost

  • Epinephrine

These are typically used under careful supervision by an ophthalmologist.

Supporting Eye Health Naturally

While there's no definitive way to naturally restore lost vitreous or aqueous humor, maintaining overall eye health can help slow degeneration:

  • Essential fatty acids

  • Bioflavonoids

  • Amino acids

  • Hyaluronic acid

  • Glucosamine sulfate

  • Silica

  • Vitamin C

A diet rich in leafy greens, citrus fruits, berries, and omega-3s supports ocular tissue and may help maintain healthy fluid dynamics.

The Importance of Prompt Treatment

Early detection and intervention are crucial. If you experience symptoms of hypotony—particularly after surgery or in the presence of inflammatory conditions—consult an eye care professional immediately. Untreated hypotony can lead to corneal folds, optic nerve damage, and permanent vision impairment.

Conclusion

Hypotony in one eye, though not as commonly discussed as high eye pressure conditions like glaucoma, is a serious medical concern. Understanding its causes, recognizing the symptoms, and seeking timely treatment are essential to preserving vision and eye health.

References:

 

© 2000-2025 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right. Library of Congress Card Number: LCN 00-192742

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