Hypotony maculopathy and choroidal detachment from repeated nocturnal ocular compression in a pediatric patient

PURPOSE: To report clinical outcomes of a pediatric patient with unilateral reversible vision loss secondary to hypotony from repeated accidental nocturnal ocular compression from circumaural headphone wear. OBSERVATIONS: A 17-year-old male with pathologic myopia and history of retinopathy of prematurity previously treated with laser ablation in both eyes presented with reduced visual acuity in his right eye from choroidal detachment and hypotony maculopathy. In the absence of uveitis and intraocular pressure lowering medications, it was determined that repeated nocturnal ocular compression from circumaural headphones created episodes of hypotony. With avoidance of this behavior and in the absence of pathologic aqueous dynamics, intraocular pressure normalized with gradual resolution of choroidal thickening and restoration to baseline visual acuity. CONCLUSIONS AND IMPORTANCE: Persistent and prolonged ocular compression, even unintentionally, can create hypotony with risk for vision loss, maculopathy, and choroidal detachment.