Choroidal Folds

Choroidal Folds
SYMPTOMS Typically asymptomatic but can be associated with metamorphopsia and a decrease in vision
SIGNS Lines or grooves (alternating between yellowish and dark colors) typically in the posterior pole that are usually horizontal (They can also be vertical or oblique)
WORK-UP Full eye exam with dilation | OCT | OCT-Angiography | Fundus autofluorescence | Fluorescein angiography (Alternating hyperfluorescent and hypofluorescent bands) | ICG | Fundus photos | Infrared photos | B-scan ultrasound
TREATMENT Treatment is based on the underlying etiology | The most common etiology is idiopathic and does not require treatment
Other etiologies that require no treatment and solely need to be monitored are scleral buckle and high hyperopia Etiologies that require treatment include retrobulbar masses, hypotony, choroidal tumors, inflammation of the sclera such as from posterior scleritis and thyroid eye disease, CNVM, and papilledema (Refer to retinal specialist if suspecting these etiologies)
FOLLOW-UP If etiology of choroidal folds is benign (Idiopathic, Scleral buckle, High hyperopia), monitor in 1 year
Once retina/choroid is stable after treatment, monitor every 4-6 months
ADDITIONAL LAB | TESTS Labs and additional tests are based on the suspected underlying etiology
ETIOLOGY Indentation of the inner surface of the sclera leads to undulations in the choroid (Biomechanical stress) which subsequently causes undulations in the RPE and sensory retina
DIFFERENTIAL DX Retinal striae, Tessellated fundus
NOTES “THIN RPE” (Etiologies for choroidal folds)
Tumors | Hypotony | Inflammation/Idiopathic | Neovascular membrane | Retrobulbar mass | Papilledema |Extraocular hardware