Ultrasound Biomicroscopic Features of Ciliary Epithelial Detachment in Bilateral Hypotony: A Novel Diagnosis

The purpose of this study was to describe the clinical and ultrasound biomicroscopy (UBM) features of a previously unreported entity, ciliary epithelial detachment, in a patient with metastatic melanoma treated with nivolumab and presenting with bilateral hypotony. Visual acuity was 0.6 logMAR in the right eye and 1.3 logMAR in the left, with intraocular pressures of 7 mmHg in the right eye and 5 mmHg in the left. UBM revealed abnormal ciliary body morphology with truncation of ciliary processes and a distinct separation at the level of the ciliary epithelium in both eyes, most prominent inferotemporally. No evidence of fibrovascular proliferation or tractional distortion suggestive of cyclitic membrane was identified. These findings suggest a novel imaging phenotype: a ciliary epithelial detachment. Recognition of this entity may improve interpretation of anterior segment imaging in hypotony and refine diagnostic classification of ciliary body pathology.