Uveitis-Associated Ocular Hypotony: A Systematic Review

Abstract

INTRODUCTION: Chronic hypotony is an uncommon but potentially vision-threatening complication of uveitis, particularly in pediatric populations. This review synthesizes current evidence on its pathophysiology, epidemiology, clinical presentation, diagnosis, management, and prognosis in adults and children. METHODS: We searched PubMed (MEDLINE), Scopus, and the Cochrane Library from March through April 2026 using the MeSH terms "Uveitis" and "Hypotony, Ocular" and the keywords "uveitis," "hypotony," and "ocular hypotony." Additional studies were identified through reference review and expert recommendation. Eligible English-language human studies addressing chronic uveitis-associated hypotony were included. Quality was assessed qualitatively. The review was registered in PROSPERO (CRD420261381085). RESULTS: Chronic uveitic hypotony is multifactorial, involving reduced aqueous production, increased uveoscleral outflow, and cyclitic membrane formation. Prevalence is ~10% in adult cohorts and 10-19% in JIA-associated pediatric uveitis. Risk factors include childhood onset, longer disease duration, severe inflammation, and prior intraocular surgery. Management is stepwise: inflammatory control with corticosteroids, steroid-sparing agents, and biologics; pharmacologic IOP elevation; and surgery combining vitrectomy, silicone oil, and fluocinolone implants. DISCUSSION: Early aggressive inflammation control is essential, as visual recovery in chronic cases is limited. Current evidence is constrained by heterogeneous definitions, inconsistent reporting, and limited pediatric data, underscoring the need for standardized evaluation and treatment approaches.