Bubbles in Clear Fluid in the Sclera

Clinical Presentation and Key Diagnostic Features

The American Academy of Ophthalmology notes that post-surgical filtering blebs typically appear as elevated, fluid-filled conjunctival elevations overlying the sclera, usually in the superior quadrant following trabeculectomy or glaucoma drainage device surgery 1
The American Academy of Ophthalmology recommends that post-surgical blebs be managed based on their integrity, with leaking blebs requiring pressure patching or surgical revision, and functional blebs being observed with routine monitoring 2
The American Academy of Ophthalmology states that conjunctival chemosis or cysts may appear as clear fluid accumulation causing conjunctival swelling, and may be associated with allergic conjunctivitis, inflammation, or venous congestion 3, 4
The American Academy of Ophthalmology notes that posterior scleritis with sub-Tenon fluid is characterized by fluid in the sub-Tenon space around the optic disc, creating a "T-sign" on B-scan ultrasonography, and is often associated with deep ocular pain, hyperemia, and painful eye movements 3, 4, 6

The American Academy of Ophthalmology recommends a detailed history, including timing of onset and prior ocular surgery, to help determine the etiology of scleral "bubbles" 1, 2, 5
The American Academy of Ophthalmology suggests that a comprehensive examination, including visual acuity measurement, intraocular pressure, slit-lamp biomicroscopy, and dilated fundus examination, be performed to localize the fluid and assess for underlying disease 2, 3, 4, 5, 6
The American Academy of Ophthalmology recommends ancillary testing, including B-scan ultrasonography, optical coherence tomography, and fluorescein and indocyanine green angiography, to further evaluate the condition and guide treatment 3, 4, 5, 6, 7, 8, 9

The American Academy of Ophthalmology recommends initiating systemic corticosteroids as first-line therapy for posterior scleritis, with oral prednisone 1 mg/kg/day and gradual taper 3, 4, 6
The American Academy of Ophthalmology notes that surgical intervention is the definitive treatment for uveal effusion syndrome, with full-thickness sclerectomies in affected quadrants to decompress vortex veins 3, 4, 6