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SYMPTOMS
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Loss of vision, Metamorphopsia, Scotomas if choroidal rupture or CNVM involves the posterior pole especially at the macula
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SIGNS
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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
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Late signs (after about 2 weeks): Yellow-white crescent shaped lesion develops fibrotic tissue and RPE hyperpigmentation along the margins
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Other ocular signs of trauma may be present, including corneal scars, iridodialysis, traumatic cataract, optic atrophy, etc.
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WORK-UP
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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
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TREATMENT
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Amsler grid
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In the presence of a choroidal rupture without macular involvement or a CNVM, monitor
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If macular involvement and a CNVM, refer to retinal specialist for further evaluation treatment (anti-VEGF)
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FOLLOW-UP
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If monitoring, monitor every 3 months for the first year
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If referred to retinal specialist: Patient will most likely be followed up by retinal specialist on a regular basis until condition is stable
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ADDITIONAL LAB | TESTS
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None, although lab tests such as orbital CT may be ordered for other ocular complications associated with trauma
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ETIOLOGY
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Rupture of the RPE, Bruch’s membrane, and choroid secondary to mechanical forces from direct or indirect trauma
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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
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The most common cause of choroidal ruptures is indirect trauma (80%)
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DIFFERENTIAL DX
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Chorioretinitis sclopetaria, Angioid streaks, Lacquer cracks
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NOTES
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Multiple choroidal ruptures can be found in about 25% of patients
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About 66% of choroidal ruptures involve the macula
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Patients with pseudoxanthoma elasticum are most susceptible to choroidal ruptures as they have a more brittle Bruch’s membrane
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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
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