We report the case of a 33-year-old woman with a history of hypothyroidism and ocular history of mild myopia who presented with a spontaneous filtering bleb. Extensive systemic rheumatologic evaluation was unrevealing. The bleb was observed for many months, until the patient's vision declined secondary to the development of hypotony maculopathy. The filtering bleb was closed using an allogenic scleral patch graft, resulting in normotensive intraocular pressure and improved best-corrected visual acuity. A unilateral, spontaneous filtering bleb is a rare occurrence and is typically associated with systemic or ocular conditions. Complications such as hypotony can lead to visual impairment, and intervention is required. Early diagnosis and repair with donor scleral patch graft can prevent complications and provide an excellent cosmetic outcome.