Use of trypan blue as an aqueous tracer dye to investigate hypotony where cyclodialysis cleft is suspected

Importance: A new method to help diagnose suspected cyclodialysis clefts. Background: To study the use of trypan blue stained aqueous flow patterns in diagnosing causes of hypotony where cyclodialysis clefts were suspected. Design: A case series in a tertiary care centre. Participants: Ten subjects presenting with persistent hypotony and retinal changes. Methods: Trypan blue was injected into the anterior chamber. Main Outcome Measures: The pattern of dye flow in the anterior chamber was categorized. Intraocular pressure prior to surgery was recorded. Results: All seven subjects with cyclodialysis clefts had a preferential flow to the cleft region. Two hypotonous subjects post trabeculectomy had rapid (5 seconds) and extensive lymphatic staining (6 o'clock hours extent) without visible bleb formation. Conclusions and Relevance: Preferential flow of dye to the limbus is a reliable sign of cyclodialysis cleft and helps localize cleft extent. A new cause of hypotony, “lymphatic overdrain,” is identified.