Choroidal Hemangioma

Choroidal Hemangioma
SYMPTOMS Blurry vision, Metamorphopsia, Visual field loss, Flashes, Floaters
Can be asymptomatic as well
SIGNS Usually isolated | Usually unilateral | Typically found in the posterior pole (Most commonly found in the superior temporal aspect of the macula)
Well-defined lesion| Orange-red in color | Can have a pigmented base | Typically no more than 6mm in diameter and 3mm in thickness | Subretinal fluid (Found in 80% of cases)
Choroidal hemangiomas can be circumscribed (No systemic association) or diffuse (associated with Sturge-Weber syndrome)
WORK-UP Full eye exam with dilation | OCT | Fundus autofluorescence | Fluorescein angiography (Lacy hyperfluorescence and subsequent leakage) | ICG (Hypercyanescence with late wash out) | Fundus photos | Infrared photos | B-scan ultrasound (Dome-shaped mass with high internal reflectivity)
TREATMENT If monitoring choroidal hemangioma, monitor in 3-6 months Once retina/choroid is stable after treatment with no signs of active subretinal fluid, monitor every 4-6 months (Watch closely for radiation retinopathy)
If asymptomatic with no evidence of subretinal fluid, no treatment needed. Monitor. Give Amsler grid. If symptomatic and/or there is evidence of subretinal fluid, refer to retinal specialist for further evaluation and treatment
Diffuse choroidal hemangiomas are more likely to cause complications. Consider referral to a retinal specialist for further evaluation and treatment
Since diffuse choroidal hemangiomas are associated with Sturge-Weber syndrome, 70% of these of these patients will have congenital glaucoma and will likely need management by a glaucoma specialist
FOLLOW-UP Frequent follow-ups are rarely necessary.
ADDITIONAL LAB | TESTS If patient presents with a diffuse choroidal hemangioma and Sturge-Weber syndrome: (1) MRI of the brain with and without contrast (2) Electroencephalogram (EEG)
ETIOLOGY Benign vascular tumor
DIFFERENTIAL DX Choroidal amelanotic melanoma, Metastatic choroidal tumor, Central serous chorioretinopathy, Posterior scleritis
NOTES ICG is the best way to confirm a choroidal hemangioma