Choroidal Rupture

Choroidal Rupture
SYMPTOMS Loss of vision, Metamorphopsia, Scotomas if choroidal rupture or CNVM involves the posterior pole especially at the macula
SIGNS Acute signs: Yellow-white crescent shaped lesion typically concentric to the optic nerve that is wider in the center and tapered at the ends, Hemorrhages (intraretinal, subretinal, preretinal, intravitreal), Possible CNVM
Late signs (after about 2 weeks): Yellow-white crescent shaped lesion develops fibrotic tissue and RPE hyperpigmentation along the margins
Other ocular signs of trauma may be present, including corneal scars, iridodialysis, traumatic cataract, optic atrophy, etc.
WORK-UP Pupils | EOMs | Full eye exam with dilation | Gonioscopy (Typically done 4-6 weeks post-trauma) | Amsler grid | OCT | OCT-Angiography | Fluorescein angiography | Fundus autofluorescence |Fundus photos |Infrared photos | B-scan ultrasound in the presence of an intravitreal hemorrhage
TREATMENT Amsler grid
In the presence of a choroidal rupture without macular involvement or a CNVM, monitor
If macular involvement and a CNVM, refer to retinal specialist for further evaluation treatment (anti-VEGF)
FOLLOW-UP If monitoring, monitor every 3 months for the first year
If referred to retinal specialist: Patient will most likely be followed up by retinal specialist on a regular basis until condition is stable
ADDITIONAL LAB | TESTS None, although lab tests such as orbital CT may be ordered for other ocular complications associated with trauma
ETIOLOGY Rupture of the RPE, Bruch’s membrane, and choroid secondary to mechanical forces from direct or indirect trauma
Choroidal ruptures found in the peripheral retina are typically caused by direct trauma and choroidal ruptures found in the posterior pole are typically caused by indirect trauma
The most common cause of choroidal ruptures is indirect trauma (80%)
DIFFERENTIAL DX Chorioretinitis sclopetaria, Angioid streaks, Lacquer cracks
NOTES Multiple choroidal ruptures can be found in about 25% of patients
About 66% of choroidal ruptures involve the macula
Patients with pseudoxanthoma elasticum are most susceptible to choroidal ruptures as they have a more brittle Bruch’s membrane
Risk factors for development of a CNVM from a choroidal rupture: · The presence of a long choroidal rupture (> 2.35mm) · The presence of the choroidal rupture in the posterior pole or macula region · Age of patient (>65 years old) · Within the first year of the choroidal rupture