TMOD (Choroid)

Choroidal Nevus

Benign

Disappear with red-free filter

Flat, grey-brown-green spot with demarcated borders

Small fraction of nevi can become choroidal melanomas (high risk of melanoma: symptoms, close to optic nerve, change/growth, elevation, orange pigment, subretinal fluid)

Choroidal Nevus Treatment/Management

Monitor with fundus photography

FU within 3 months at first, then 1-12 months depending on risk level

Choroidal Melanoma

Most common primary intraocular malignancy in adults

Most common sites of metastasis include liver, lung, bone, skin, CNS

Dome shaped elevations may or may not be pigmented with overlying yellow/orange lipofuscin, indistinct borders, may have associated serous retinal detachment

Choroidal Melanoma Treatment/Management

Enucleated (leave EOM and orbital content) to prevent metastasis

Refer to oncologist

Choroidal Melanoma prognosis

If metastasizes, 15-45% mortality rate within 10 years

Choroidal Metastasis

Most common intraocular malignancy in adults

When cancer has spread to the eye from another place in the body (#1 primary site is breast in women, lung in men)

Yellow-white elevated lesions with pigmented clumps (leopard spots) and possible overlying serous retinal detachment

Choroidal Metastasis Treament/Management

Refer to oncologist for chemo

Choroidal Metastasis prognosis

Pt will die within 1 year of diagnosis

Choroideremia

X-linked recessive inheritance (men affected, women are carriers)

Bilateral

Presents at 20-30yo and progress to legal blindness by 50-60yo

Nyctalopia, photophobia, peripheral vision loss

Peripheral atrophy of choriocapillaris, revealing choroidal vessels and sclera, spares macula until late stage

Choroideremia Treatment/Management

No tx

Low vision consult may be beneficial

Central Areolar Choroidal Dystrophy

AD inheritance

Shows at age 30-40

Progresses to severe vision loss by 60-70

Blur and central scotoma, bilateral and symmetric, moderate protan-deutan defect

In early stage hypopigmentation of the macula that progress to geographic atrophy that slowly enlarge and show choroidal vasculature

Decrease from 20/25-20/200

Central Areolar Choroidal Dystrophy Treatment/Management

No tx

Low vision consult

Serpiginous Choroidopathy

HLA-B7

Idiopathic in nature

Presents in 50-60yo men

Central blur, scotoma that is unilateral or bilateral, CNV

Recurrent disease that begins at the optic nerve then grows towards macula

Active - grey-white in color

Dormant - shows atrophy and scar

Serpiginous Choroidopathy Treatment/Management

Poor response to tx

If inflammation, tx with steroids (oral, sub-tenons)

If CNV, laser photocoagulation and anti-VEGF

May benefit from low vision consult

Serpiginous Chroidopathy prognosis

Poor visual outcome

Candidiasis

Fungal infection of Candida and typically seen. in IV drug abusers

Bilateral blur, pain, floaters, RD in late stage

Yellow-white choroidal lesions that progress into a hazy vitritis that looks like “cotton balls”

Candidiasis Treatment/Management

Antifungal (oral or IV)

If vitreous is involved, then do intravitreal injection or vitrectomy if mod to serever inflammation or steroids

May need to monitor daily or hospitalized if pt is noncompliant with tx

Infectious disease specialist should be consulted

Birdshot Retinochoroidopathy (Vitiliginous Chorioretinitis)

HLA-A29

White dot syndrome

Idiopathic, bilateral, chronic, recurrent

Usually seen in white females age 40-60

Floaters, blur

Presents with multiple creamy yellow-white small (1DD) spots (spares macula), mild bouts of recurrent anterior uveitis, vitritis, vasculitis, CNVM, ERM, CME

Birdshot Retinochoroidopathy (Vitiliginous Chorioretinitis) Treatment/Management

Significant inflammation, tx with steroids (oral or sub-tenons)

Vitritis or CME, tx with cyclosporine

Serous Choroidal Detachment (Choroidal Effusion)

Low IOP from puncture wound to the globe

Could also be associated with posterior scleritis, VKH syndrome, trauma, intraocular tumor

WILL transilluminate

Asymptomatic

Choroid separates from sclera (looks the same as hemorrhagic choroidal detachment

Serous Choroidal Detachment (Choroidal Effusion) Treatment/Management

Close wound with bandage CL, suture, cyanoacrylate glue

Hemorrhagic Choroidal Detachment

Increased IOP secondary to hemorrhaging during anterior segment surgery

Severe pain, red eye, rapid decreased vision

WILL NOT transilluminate

Hemorrhagic Choroidal Detachment Treatment/Management

Wound should close immediately

Sclerotomy (cutting the sclera)

Cycloplegic to prevent synechiae

Ocular hypotensives to reduce IOP