Three-dimensional (3D) image rendering capability of a commercially available 3D-optical coherence tomogram (OCT) system was used to diagnose a subclinical but symptomatic case of hypotony maculopathy in an eye with significant cataract and an only-eyed patient. Bleb revision improved intraocular pressure and symptoms, confirmed by repeat OCT imaging. Hypotony maculopathy may be subclinical and difficult to diagnose particularly in eyes with non-clear ocular media. Use of spectral domain OCT can be complementary to improve patient outcomes.