| Choroidal Rupture Signs and Symptoms
Patients who experience choroidal rupture are often younger and involved in
activities, such as ball sports, which expose them to potential high-rate impact trauma to
the eye or adenexa. Patients have a history, either recent or antecedent, of direct or
contrecoup injury to the eye and surrounding structures.
Choroidal ruptures may be single or multiple and may affect any part of
the posterior segment. In recent trauma, there may be hemorrhage in any layer ranging from
the choroid to the vitreous. However, if the trauma was many years antecedent, there will
be no hemorrhage unless choroidal neovascularization has developed. Visual acuity and
visual field may be dramatically reduced or may be normal and the patient is asymptomatic.
Ophthalmoscopically, you will note a linear disruption that may be
crescent-shaped. Often, the rupture will have the concave aspect toward the disc. There is
usually significant reactive RPE hyperplasia, giving the rupture a pigmented appearance.
Pathophysiology
Direct or contrecoup injury can precipitate a choroidal rupture. Hemorrhage
and edema may be present initially, but will resolve. Typically, reactive hyperplasia
gives the rupture a heavily pigmented appearance. Often, the overlying retina is
undisturbed in choroidal rupture. However, if the RPE is disturbed and becomes
hyperplastic and invades the sensory retina, visual dysfunction ensues.
Due to the subsequent disruption of Bruch’s membrane that occurs in
choroidal rupture, choroidal neovascular membranes may develop within the rupture. This
may be a late development that can occur up to five years after the precipitating trauma.
Management
There is no direct intervention in the acute phase of choroidal rupture.
Educate patients about their condition and prescribe protective eye wear. Monitor the
patient funduscopically for at least five years for the development of choroidal
neovascularization within the rupture scar. Any late bleeding should receive a fluorescein
angiogram to determine if a choroidal neovascular membrane has developed. Choroidal
neovascular membranes resulting from choroidal rupture have a tendency to spontaneously
involute. For this reason, laser photocoagulation is indicated only if there is imminent
threat to vision.
Clinical Pearls
Choroidal neovascularization can occur five years after
the initial trauma.
Sub-retinal hemorrhage from choroidal neovascularization
is the most common cause of late vision loss.
As the retina overlying a choroidal rupture may be
unaffected, patients may retain excellent visual function and present asymptomatically
years after the trauma. A patient may have a rupture between the disc and macula, yet
retain normal acuity.
Other reports in this section
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