Ciliary Body Injury

Ocular trauma is a major challenge for ophthalmologists. In this context, the ciliary body can be affected directly or indirectly by blunt or open trauma, leading to complications in the dynamics of the aqueous humor and intraocular pressure (IOP) control, accommodative changes, and anatomical distortions in the posterior segment. Hypotonia can result from cyclodialysis, which promotes increased drainage through the uveoscleral pathway, and can lead to visual loss from induced hyperopia and hypotonic maculopathy. Considering the potential irreversible damage to the choroid and retina, early diagnosis is necessary with a complete workup, including detailed biomicroscopic examination, gonioscopy, and imaging methods, particularly necessary in cases of corneal edema and hyphema, making it impossible to adequately perform anterior segment slit lamp evaluation. Ultrasound biomicroscopy (UBM) is a high-frequency diagnostic method that provides excellent resolution to evaluate the ciliary body, allowing the diagnosis of conditions such as angle recession, iridodialysis, cyclodialysis cleft, and ciliary body detachments, in addition to the detection of foreign bodies. Anterior segment optical coherence tomography (AS-OCT) is a noncontact method especially useful in cases of penetrating trauma treated surgically for monitoring the wound-healing process after surgery, with accuracy and resolution similar to UBM. Other advantages include the visualization of foreign bodies, in addition to repeatability. However, it presents limitations for visualizing structures posterior to the iris. The cyclodialysis management flowchart starts with conservative approaches such as the use of cycloplegic drugs in the expectation of spontaneous closure, especially in small clefts. Laser therapies may be an intermediate step, and finally, cyclopexy is considered in larger clefts or refractory cases.