eMedicine Specialties > Ophthalmology > Choroid

Choroidal Rupture: Differential Diagnoses & Workup

Author: Lihteh Wu, MD, Consulting Surgeon, Department of Ophthalmology, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Coauthor(s): Teodoro Evans, MD, Retina Fellow, St Michael's Hospital, University of Toronto, Canada
Contributor Information and Disclosures

Updated: Nov 16, 2009

Differential Diagnoses

Angioid Streaks
ARMD, Exudative
Neovascular Membranes, Subretinal
Neovascularization, Choroidal
Presumed Ocular Histoplasmosis Syndrome
Pseudoxanthoma Elasticum

Workup

Imaging Studies

Because choroidal ruptures occur as a consequence of blunt ocular trauma, the ocular examination must be thorough to rule out orbital fractures or globe ruptures.

  • Consider CT scanning and MRI of the eye and orbit under appropriate circumstances.
  • Fluorescein angiography may be a useful adjunct to detect CNV.
    • If CNV is absent, hypofluorescence occurs during the early phase of the angiogram due to disruption of the choriocapillaris. During later stages, hyperfluorescence occurs from the adjacent healthy choriocapillaris.
    • If CNV is present, early hyperfluorescence followed by late leakage is present on the angiogram.
  • Indocyanine green (ICG) angiography may be useful if subretinal blood blocks or hides CNV detection on a fluorescein angiogram.

Histologic Findings

Direct choroidal ruptures are characterized by a complete absence of choroid and RPE. The overlying retina is intact but atrophic.

In indirect choroidal ruptures, CNV is a common finding during the early healing phases. Most CNV is in the subretinal space (Gass type 2). With time, most CNV involutes spontaneously. In a small number of cases, a disciform scar or fibrous tissue may grow into the retina and vitreous cavity.

More on Choroidal Rupture

Overview: Choroidal Rupture
Differential Diagnoses & Workup: Choroidal Rupture
Treatment & Medication: Choroidal Rupture
Follow-up: Choroidal Rupture
Multimedia: Choroidal Rupture
References
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References

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Further Reading

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Keywords

choroidal rupture, choroidal ruptures, choroidal break, Bruch membrane, Bruch's membrane, retinal pigment epithelium, RPE, choroidal neovascularization, CNV

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Contributor Information and Disclosures

Author

Lihteh Wu, MD, Consulting Surgeon, Department of Ophthalmology, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Lihteh Wu, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Pan-American Association of Ophthalmology, and Retina Society
Disclosure: Nothing to disclose.

Coauthor(s)

Teodoro Evans, MD, Retina Fellow, St Michael's Hospital, University of Toronto, Canada
Disclosure: Nothing to disclose.

Medical Editor

Russell P Jayne, MD, Consulting Vitreoretinal Surgeon, The Retina Center at Las Vegas
Russell P Jayne, MD is a member of the following medical societies: American Medical Association, American Society of Cataract and Refractive Surgery, and American Society of Retina Specialists
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians & Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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