eMedicine Specialties > Ophthalmology > Choroid

Choroidal Rupture

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, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Contributor Information and Disclosures

Updated: Jul 19, 2007

Introduction

Background

Choroidal ruptures are breaks in the choroid, the Bruch membrane, and the retinal pigment epithelium (RPE) that result from blunt ocular trauma (the most common eye injury). Choroidal rupture can be secondary to indirect or direct trauma. Cases secondary to direct trauma tend to be located more anteriorly and at the site of impact and parallel to the ora, whereas those secondary to indirect trauma occur posteriorly. These ruptures have a crescent shape and are concentric to the optic disc. Indirect choroidal ruptures are almost 4 times more common than direct ruptures.

Pathophysiology

After blunt trauma, the ocular globe undergoes mechanical compression and then sudden hyperextension. Because of its tensile strength, the sclera can resist this insult; the retina is also protected because of its elasticity. The Bruch membrane does not have enough elasticity or tensile strength; therefore, it breaks.

Concurrently, the small capillaries in the choriocapillaris are damaged, leading to subretinal or sub-RPE hemorrhage. Hemorrhage in conjunction with retinal edema may obscure the choroidal rupture during the acute phases. The deep choroidal vessels are usually spared. As the blood clears, a white, curvilinear, crescent-shaped streak concentric to the optic nerve is seen.

During the healing phase, choroidal neovascularization (CNV) occurs. In most cases, it involutes spontaneously. If the rupture does not involve the fovea, good vision is expected. In 15-30% of patients, CNV may arise again and lead to a hemorrhagic or serous macular detachment with concomitant visual loss. This usually occurs during the first year but can also occur decades later. Older age and macular rupture, the length of the rupture, and the distance of the rupture to the center of the fovea may be risk factors for CNV.

Frequency

United States

Blunt ocular trauma is the most common type of eye injury. Approximately 5-10% of patients with such injury develop a choroidal rupture. Most eyes have a single rupture, but up to 25% of eyes have multiple ruptures. About 80% of ruptures occur temporal to the disc, and 66% involve the macula.

Mortality/Morbidity

Vision loss depends on whether the choroidal rupture involves the fovea and whether and where CNV occurs.

Sex

  • Men appear to be more prone to ocular trauma than women.
  • A male-to-female ratio of 5:1 is reported for choroidal ruptures.1,2

Age

In most series, this condition occurs in patients aged 20-40 years.1,2

Clinical

History

  • History of blunt trauma
  • History of angioid streaks
  • Paracentral or central scotoma
  • Decreased vision

Physical

  • Retinal edema
  • Hemorrhagic detachment of the macula
  • Serous detachment of the macula
  • Subretinal hemorrhage
  • White curvilinear crescent-shaped streak concentric to the optic nerve

Causes

  • Blunt trauma
  • Angioid streaks

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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  2. White MF Jr, Morris R, Feist RM, et al. Eye injury: prevalence and prognosis by setting. South Med J. Feb 1989;82(2):151-8. [Medline].

  3. Gross JG, King LP, de Juan E Jr, Powers T. Subfoveal neovascular membrane removal in patients with traumatic choroidal rupture. Ophthalmology. Apr 1996;103(4):579-85. [Medline].

  4. Aguilar JP, Green WR. Choroidal rupture. A histopathologic study of 47 cases. Retina. Fall-Winter 1984;4(4):269-75. [Medline].

  5. Ament CS, Zacks DN, Lane AM, Krzystolik M, D'Amico DJ, Mukai S, et al. Predictors of visual outcome and choroidal neovascular membrane formation after traumatic choroidal rupture. Arch Ophthalmol. Jul 2006;124(7):957-66. [Medline].

  6. Bellows JG. Observations on 300 cases of ocular war injuries. Am J Ophthalmol. 1947;30:309-323.

  7. Conrath J, Forzano O, Ridings B. Photodynamic therapy for subfoveal CNV complicating traumatic choroidal rupture. Eye. Sep 2004;18(9):946-7. [Medline].

  8. Eagling EM. Ocular damage after blunt trauma to the eye. Its relationship to the nature of the injury. Br J Ophthalmol. Feb 1974;58(2):126-40. [Medline].

  9. Fuller B, Gitter KA. Traumatic choroidal rupture with late serous detachment of macula. Report of successful argon laser treatment. Arch Ophthalmol. Apr 1973;89(4):354-5. [Medline].

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  11. Hart JC, Natsikos VE, Raistrick ER, Doran RM. Indirect choroidal tears at the posterior pole: a fluorescein angiographic and perimetric study. Br J Ophthalmol. Jan 1980;64(1):59-67. [Medline].

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  16. Mennel S, Hausmann N, Meyer CH, Peter S. Photodynamic therapy and indocyanine green guided feeder vessel photocoagulation of choroidal neovascularization secondary to choroid rupture after blunt trauma. Graefes Arch Clin Exp Ophthalmol. Jan 2005;243(1):68-71. [Medline].

  17. Pearlstone AD. Delayed loss of central vision following multiple posterior segment trauma. Ann Ophthalmol. Apr 1980;12(4):409-11. [Medline].

  18. Secrétan M, Sickenberg M, Zografos L, Piguet B. Morphometric characteristics of traumatic choroidal ruptures associated with neovascularization. Retina. 1998;18(1):62-6. [Medline].

  19. Smith RE, Kelley JS, Harbin TS. Late macular complications of choroidal ruptures. Am J Ophthalmol. May 1974;77(5):650-8. [Medline].

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  21. Wood CM, Richardson J. Chorioretinal neovascular membranes complicating contusional eye injuries with indirect choroidal ruptures. Br J Ophthalmol. Feb 1990;74(2):93-6. [Medline].

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Further Reading

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Keywords

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, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

Teodoro Evans, MD, Retina Fellow, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
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
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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