The choroid is a spongy layer of blood vessels that lines the back wall of the eye between the retina and the sclera (or the white part of the eye). It plays an important role in delivering oxygen and nutrients to the outer half of the retina. The choroid is normally directly next to the sclera, but can be displaced by fluid or blood, leading to a choroidal detachment.

Choroidal detachments occur when there is an accumulation of fluid or blood in the suprachoroidal space, a potential space situated between the choroid and the sclera. They are an uncommon ocular pathology. The most common cause of choroidal detachment is secondary to trabeculectomy; however, there are other causes such as trauma and inflammation. Clinically, choroidal detachments may vary in presentation from asymptomatic, to very poor vision, severe ocular pain, vomiting and nausea. Ocular findings associated with choroidal detachments include serous retinal detachment, secondary angle closure, and a very shallow anterior chamber.

Choroidal detachments are rare conditions that occur when there is an accumulation of fluid or blood in the suprachoroidal layer, located between the choroid and sclera. This condition is known by several terms within the literature, including choroidal effusion, uveal effusion, ciliochoroidal detachment, and ciliochoroidal effusion; however, all refer to the same pathological process.

Symptoms

When the choroid is detached from the back wall of the eye, patients may not feel anything at all, or may feel that the eye is achy and sore. In some cases, a choroidal detachment can cause more severe pain. Often, the vision is blurred as well, though the degree of blurring varies and often relates to other eye issues that can accompany a choroidal detachment, such as recent surgery, or high or low pressure in the eye.

Causes

In general, choroidal detachments can be categorized as “serous”, or “hemorrhagic”. Serous choroidal detachments are typically associated with a low pressure in the eye and are usually only mildly uncomfortable. In contrast, hemorrhagic choroidal detachments are commonly painful, and often associated with a high intraocular pressure. Serous choroidal detachments most commonly occur in the setting of low intraocular pressure after eye surgery. Inflammation, trauma, cancer, and certain medications can also cause a serous choroidal detachment to occur. In some patients, especially in those who are far-sighted, serous choroidal detachments can occur spontaneously.

In contrast, hemorrhagic choroidal detachments occur when a choroidal blood vessel bursts and suddenly fills the space between the choroid and the sclera with blood. This most often occurs during surgery but can occur following surgery, and is more frequent in older patients with a history of hardening of the arteries, or who use medications to thin their blood.

Treatment for Choroidal Detachment

Choroidal detachments are generally treated with topical medications, such as eye drops, that help reduce inflammation and dilate the pupil. Small postoperative choroidal detachments often heal on their own a few days after surgery.

In some cases, choroidal detachments require surgical drainage. The timing of this surgery depends on many factors, including the status of the structures inside the eye, the pressure in the eye, and the amount of time that has passed since the choroidal detachment first occurred. The visual prognosis is more guarded in eyes with massive hemorrhagic choroidal detachments, but most eyes with choroidal detachments have a good visual prognosis, whether or not treatment is required.

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