Choroidal detachment occurs when the retina and choroid become lifted from the sclera by an accumulation of either serous fluid or blood. For this reason, a choroidal detachment is often secondary to another ocular condition.
- The etiology of serous choroidal detachment is often related to low intraocular pressure (IOP) (hypotony) after surgery or trauma, or secondary to inflammation. Low IOP particularly <5 mmHg, is liable to promote transudation of serum out of the choroidal vasculature, causing lifting of the choroid.
- Hemorrhagic choroidal detachment may also follow surgery or trauma, or result from an abnormal vasculature such as choroidal neovascularization. Surgery or trauma may cause rupture of the short posterior ciliary arteries or other vascular trauma, leading to bleeding.
- Choroidal detachment in the absence of apparent cause has been termed ‘uveal effusion syndrome’ or ‘idiopathic ciliochoroidal effusion’.
Choroidal detachment may be asymptomatic or associated with decreased vision. Pain may be associated with hemorrhagic choroidal detachment and experienced in severe serous choroidal detachment.
The elevation of both the retina and choroid may be the only abnormal sign. The elevation may be in a localized dome shape, or 360° around the periphery, with a lobular shape caused by the limits of the fibrous attachments of the choroidal vascular supply. Unlike a retinal detachment, the raised tissue shows little movement (tremulousness) with eye movements, the color is homogeneous and the retinal vessels look normal. In the worst case, very large peripheral elevations may contract together in the vitreous cavity, known as ‘kissing choroidals’. Choroidal detachment, related to suprachoroidal hemorrhage, can appear with a localized dark-brown elevation, somewhat like a malignant melanoma. In either serous or hemorrhagic choroidal detachment, the anterior chamber may be shallow with mild cell flare. The IOP may be very low in serous choroidal detachment, or high in a marked hemorrhagic detachment.
Rare (approximately 1/10,000)
Blurred vision. Possible complications include phthisis or retinal detachment.
Retinal detachment – rhegmatogenous; choroidal melanoma (malignant melanoma).
Urgent Specific treatment is often required for the underlying problem. Choroidal detachment is often related to globe hypotony, trauma, post-surgical complications, inflammation, neoplasm or hemorrhage.
Ocular tests, imaging, additional investigations Additional tests may be required to confirm the diagnosis or differentiate other conditions. If there is a suspicion of choroidal melanoma, fluorescein angiography may be useful. Bscan ultrasonography may also be useful for differentiating serous and hemorrhagic choroidal detachments.
Topical steroids and cycloplegics are usually prescribed, for example: atropine 1% t.i.d. and prednisolone acetate 1% q.i.d.. If the IOP is high such as in hemorrhagic choroidal detachments, then a restricted range of anti-glaucoma medications can be used, avoiding the Parasympathomimetics (miotics) and the pro-inflammatory Prostaglandin analogs or similar. Possible examples are the beta-blockers, alpha-agonists or Carbonic anhydrase inhibitors.
atropine 1 per cent three times daily and prednisolone acetate 1 per cent four times daily. If the IOP is high, such as in hemorrhagic choroidal detachments, then a restricted range of anti-glaucoma medications can be used, avoiding the parasympathomimetics (miotics) and the proinflammatory prostaglandin analogues or similar drugs. Possible examples are the p blockers, a agonists or carbonic anhydrase inhibitors.
Incisional surgery Surgical drainage of the suprachoroidal fluid may be indicated if the anterior chamber is flat or there is risk of lens-cornea
contact or there is anterior chamber inflammation, creating risk of peripheral anterior synechiae, in the presence of ‘kissing choroidals’, with hemorrhagic disease, or if the condition fails to resolve after treatment of the underlying condition.
Review If an underlying condition can be identified and treated, the choroidal detachment may be simply monitored for resolution over the next week or so.