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SYMPTOMS
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Blurry vision, Metamorphopsia, Visual field loss, Flashes, Floaters
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Can be asymptomatic as well
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SIGNS
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Usually isolated | Usually unilateral | Typically found in the posterior pole (Most commonly found in the superior temporal aspect of the macula)
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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)
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Choroidal hemangiomas can be circumscribed (No systemic association) or diffuse (associated with Sturge-Weber syndrome)
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WORK-UP
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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)
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TREATMENT
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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)
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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
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Diffuse choroidal hemangiomas are more likely to cause complications. Consider referral to a retinal specialist for further evaluation and treatment
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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
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FOLLOW-UP
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Frequent follow-ups are rarely necessary.
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ADDITIONAL LAB | TESTS
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If patient presents with a diffuse choroidal hemangioma and Sturge-Weber syndrome: (1) MRI of the brain with and without contrast (2) Electroencephalogram (EEG)
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DIFFERENTIAL DX
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Choroidal amelanotic melanoma, Metastatic choroidal tumor, Central serous chorioretinopathy, Posterior scleritis
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NOTES
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ICG is the best way to confirm a choroidal hemangioma
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