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Choroidal Detachment and Hemorrhage

Choroidal Detachment and Hemorrhage is a condition when the choroid layer detaches from the underlying eye tissue.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Choroidal Detachment and Haemorrhage
  • Haemorrhagic Choroidal Detachment
  • Hemorrhagic Choroidal Detachment

What is Choroidal Detachment and Hemorrhage? (Definition/Background Information)

  • Choroidal Detachment and Hemorrhage is a condition when the choroid layer detaches from the underlying eye tissue. The detached area may be filled with blood or fluid
  • The choroid is a portion of the uvea (part of the eye structure) that is predominantly made up of blood vessels. The choroid provides nutrients to the retina keeping it healthy
  • The cause of Choroidal Detachment and Hemorrhage includes a host of factors such as eye injuries, abnormal intraocular pressure, certain medications causing side effects that affect the eye, and medical procedures involving the eye
  • Hemorrhagic Choroidal Detachment results in signs and symptoms that include eye floaters, reduced vision, and sensation of eye flashes. If left untreated, complications may even result in vision loss
  • A healthcare provider can use various physical (eye) exams, blood tests, and imaging studies to diagnose Choroidal Detachment and Hemorrhage. Upon diagnosis, the treatment options include addressing the underlying condition and the use of medications to control pain and inflammation
  • The prognosis for Choroidal Detachment and Hemorrhage depends on each individual's signs and symptoms and the severity and type of the underlying condition. The condition can lead to permanent blindness, if left undiagnosed or untreated

Who gets Choroidal Detachment and Hemorrhage? (Age and Sex Distribution)

  • Choroidal Detachment and Hemorrhage can present itself at any age, but is more likely to occur in elderly adults
  • Both males and females are affected and no particular predilection is noted
  • Individuals of different racial and ethnic backgrounds can be affected

What are the Risk Factors for Choroidal Detachment and Hemorrhage? (Predisposing Factors)

The risk factors for Choroidal Detachment and Hemorrhage may include:

  • Injury to the eye, due to participation in sports or occupation-related
  • Surgery to eye
  • Glaucoma
  • Certain drugs are known to induce the condition
  • Rarely, Hemorrhagic Choroidal Detachment can occur due to coughing, sneezing, and strained bowel movement. Thus, the risk factors may include acute/chronic bronchitis, severe allergies, and sinusitis

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Choroidal Detachment and Hemorrhage? (Etiology)

Choroidal Detachment and Hemorrhage may be caused by several factors that include:

  • Eye trauma
  • Abnormal inflammation in the eye caused by many factors
  • Iatrogenic causes; from medical procedures that involve the eye
  • Side effects of certain medications that include blood thinners and anticoagulants
  • Tumors of the eye
  • Low or high intraocular (eye fluid) pressure due to several causes
  • Sickle cell anemia
  • Myopia
  • Severe atherosclerosis

What are the Signs and Symptoms of Choroidal Detachment and Hemorrhage?

The signs and symptoms of Choroidal Detachment and Hemorrhage may vary between individuals and may include:

  • Vision abnormalities including field defects
  • Small specks, called floaters, that may be seen moving through one's field of vision is observed in one-third of the individuals
  • Flashes of light in the eye, or photopsia
  • In a majority no pain is observed; occasionally, severe pain may be experienced. Post-op detachments (following a surgical procedure) may be painful
  • The condition is normally unilateral and one eye is affected, but both eyes can be involved

The presentations of any underlying condition may also be observed.

How is Choroidal Detachment and Hemorrhage Diagnosed?

A healthcare professional may diagnose Choroidal Detachment and Hemorrhage using the following tests and procedures:

  • Physical examination and analysis of previous medical history
  • Eye examination by an eye specialist
  • Fundoscopic (ophthalmoscopic) examination by an eye specialist, who examines the back part of the eye (or the fundus)
  • Visual acuity test using a special and standardized test chart (Snellen chart)
  • Slit-lamp examination: Examination of the eye structure using a special instrument called a slit-lamp. In this procedure, the pupils are dilated and the internal eye structure is examined
  • Tonometry: Measurement of intraocular pressure or eye fluid pressure, especially to detect conditions such as glaucoma
  • Fundus fluorescein angiography (FFA): In this technique, the eye blood vessels are examined using a fluorescein dye
  • Fundus autofluorescence (FAF) imaging: It is a diagnostic technique to examine the fundus of the eye using a fluorescent dye
  • Indocyanine green (ICG) angiography: It is used to examine the blood vessels of the choroid using a dye, called indocyanine green, particularly to study the choroid
  • B-scan ultrasonography: Special ultrasound scan of the eye through a non-invasive diagnostic tool, to assess health of the eye structures
  • Electroretinogram (ERG): It is a technique to measure electrical activities in the retinal cells
  • Optical coherence tomography (OCT) of eye: Radiological imaging technique to visualize the eye structure
  • Blood tests that include:
    • To check for the presence of antibodies in blood
    • Blood culture for infections
    • Complete blood count (CBC) with differential
    • Erythrocyte sedimentation rate (ESR)
  • Other tests to determine any underlying condition causing Hemorrhagic Choroidal Detachment

If individuals have other signs and symptoms, then the following tests may be performed:

  • Chest X-rays
  • Neuroimaging studies including MRI scan of brain
  • Lumbar puncture: In this procedure, the cerebrospinal fluid is collected and analyzed

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Choroidal Detachment and Hemorrhage?

Complications of Choroidal Detachment and Hemorrhage may lead to vision abnormalities and may include:

  • Choroidal neovascularization (CNV): An abnormal development of blood vessels in the choroid, which if left untreated can result in permanent loss of vision
  • Glaucoma: A condition that can cause blindness due to higher intraocular pressure
  • If left undiagnosed and/or untreated, the condition can lead to permanent vision loss
  • Kidney damage, high blood sugar, and high blood pressure due to steroid treatment

How is Choroidal Detachment and Hemorrhage Treated?

Early diagnosis and treatment of Choroidal Detachment and Hemorrhage is important. This can help prevent complications which may cause in irreversible damage to the eye. The treatment is dependent on the underlying cause and may include the following measures:

  • Oral medications (including pain medications)
  • Oral corticosteroids are generally effective and may be given to control inflammation. Steroids may also be administered intravenously depending on the underlying cause
  • Addressing underlying conditions that may be contributing to progression of the disorder, such as by:
    • Immediate first aid treatment of an eye injury can significantly help improve the individual's chance to maintain their vision
    • If the condition is drug-induced, then the medication causing the condition should be stopped immediately; the healthcare provider may recommend a different category of drug(s)
    • Appropriate surgical or other treatment of any tumors affecting the eye
    • Use of eye drops or suitable surgical procedures to address glaucoma
    • Undertaking suitable treatment of sickle cell anemia through blood transfusions, bone marrow transplants, and regular health visits
    • Wearing eye glasses or contact lenses for myopia; surgical corrections using laser or lens implants
    • Appropriate dietary modification, use of medications, and/or surgery to treat atherosclerosis
  • If the underlying cause is unknown, then decreasing inflammation is the main step towards treating Hemorrhagic Choroidal Detachment
  • If choroidal neovascularization is observed, then laser therapy may be helpful
  • The healthcare provider may recommend surgical treatment to rectify the choroidal defect or reattach the choroid

It is important to note that steroids may not be used in all cases, since it can worsen the condition. A healthcare provider will provide the best treatment options based upon each individual’s specific circumstances.

How can Choroidal Detachment and Hemorrhage be Prevented?

It may be difficult to prevent Choroidal Detachment and Hemorrhage, but the risk for the condition may be lowered through the following measures:

  • Educating the individual and family members about the underlying cause and preventing the development of any modifiable risk factors associated with the underlying condition (if possible)
  • Wearing protective gear (such as industrial goggles or protective glasses) during activities that have an increased risk for eye trauma
  • Reduce risk for atherosclerosis by avoiding smoking, minimizing stress, and having a healthy lifestyle (diet and exercise)
  • Early detection and correction of nearsightedness can prevent the condition from worsening
  • Undertake regular eye examinations and treat elevated or lowered eye fluid pressure immediately
  • If the condition is medication-induced, then stopping the medication causing the condition as early as possible is important; alternative medications may be prescribed
  • Maintaining long-term follow-up checkups

What is the Prognosis of Choroidal Detachment and Hemorrhage? (Outcomes/Resolutions)

  • The prognosis of Choroidal Detachment and Hemorrhage depends upon the severity of the underlying condition and the signs and symptoms
  • An early diagnosis and adequate treatment can ensure better prognosis than late detections and delayed treatment. In such cases, Choroidal Detachment and Hemorrhage can result in permanent loss of vision

Additional and Relevant Useful Information for Choroidal Detachment and Hemorrhage:

Uvea: The uvea is a part of the eye that consists of 3 structures, namely the iris, the ciliary body, and the choroid.

  • Iris: It is the colored portion of the eye; the iris surrounds the pupil of the eye
  • Ciliary body: It is located between the iris and choroid portion of uvea. Ciliary bodies help in attaching the lens in the eye. It also helps provide nutrients to the lens
  • Choroid: It is a portion of the uvea that is predominantly made up of the blood vessels; choroid provides nutrients to the retina keeping it healthy

Please visit our Eye & Vision Health Center for more physician-approved health information:


What are some Useful Resources for Additional Information?

American Optometric Association
243 N. Lindbergh Boulevard St. Louis, MO 63141
Toll-Free: 1 (800) 365-2219
Website: http://www.aoa.org

National Eye Institute (NEI)
Information Office 31 Center Drive
MSC 2510 Bethesda, MD 20892-2510
Phone: (301) 496-5248
Email: 2020@nei.nih.gov
Website: http://www.nei.nih.gov

National Institute of Allergy and Infectious Diseases (NIAID)
Office of Communications and Government Relations
6610 Rockledge Drive, MSC 6612, Bethesda, MD 20892-6612
Phone: (301) 496-5717
Toll-Free: (866) 284-4107
TDD: (800) 877-8339 (for hearing impaired)
Fax: (301) 402-3573
Email: ocpostoffice@niaid.nih.gov
Website: http://www.niaid.nih.gov

References and Information Sources used for the Article:

https://nei.nih.gov/health/uveitis/uveitis (accessed on 09/15/16)

https://medlineplus.gov/ency/article/000595.htm (accessed on 09/15/16)

https://www.asrs.org/patients/retinal-diseases/11/choroidal-detachment (accessed on 09/15/16)

http://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/choroidal-detachments/HAK.htm (accessed on 09/15/16)

http://www.ncbi.nlm.nih.gov/pubmed/11787743 (accessed on 09/15/16)

Helpful Peer-Reviewed Medical Articles:

Koh, A., Lee, W. K., Chen, L. J., Chen, S. J., Hashad, Y., Kim, H., ... & Weisberger, A. (2012). EVEREST study: efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy. Retina, 32(8), 1453-1464.

Andreoli, M. T., Yiu, G., Hart, L., & Andreoli, C. M. (2014). B-scan ultrasonography following open globe repair. Eye, 28(4).

Lee, Y. A., Yang, C. H., Yang, C. M., Ho, T. C., Lin, C. P., Huang, J. S., & Chen, M. S. (2012). Photodynamic therapy with or without intravitreal bevacizumab for polypoidal choroidal vasculopathy: two years of follow-up.American journal of ophthalmology, 154(5), 872-880.

Gedde, S. J., Herndon, L. W., Brandt, J. D., Budenz, D. L., Feuer, W. J., Schiffman, J. C., & Tube Versus Trabeculectomy Study Group. (2012). Postoperative complications in the Tube Versus Trabeculectomy (TVT) study during five years of follow-up. American journal of ophthalmology,153(5), 804-814.

Bertolotto, M., Serafini, G., Sconfienza, L. M., Lacelli, F., Cavallaro, M., Coslovich, A., ... & Cova, M. A. (2014). The use of CEUS in the diagnosis of retinal/choroidal detachment and associated intraocular masses–preliminary investigation in patients with equivocal findings at conventional ultrasound.Ultraschall in der Medizin-European Journal of Ultrasound, 35(02), 173-180.

Koizumi, H., Yamagishi, T., Yamazaki, T., & Kinoshita, S. (2013). Relationship between clinical characteristics of polypoidal choroidal vasculopathy and choroidal vascular hyperpermeability. American journal of ophthalmology, 155(2), 305-313.

Yannuzzi, L. A., & Shakin, J. L. (2012). Krypton red laser photocoagulation of the ocular fundus. Retina, 32, 1-14.

Tomita, K., Tsujikawa, A., Yamashiro, K., Ooto, S., Tamura, H., Otani, A., ... & Yoshimura, N. (2012). Treatment of polypoidal choroidal vasculopathy with photodynamic therapy combined with intravitreal injections of ranibizumab.American journal of ophthalmology, 153(1), 68-80.

Roy, F. H. (2012). Ocular differential diagnosis. JP Medical Ltd.

Cho, H. J., Koh, K. M., Kim, H. S., Lee, T. G., Kim, C. G., & Kim, J. W. (2013). Anti–Vascular Endothelial Growth Factor Monotherapy in the Treatment of Submacular Hemorrhage Secondary to Polypoidal Choroidal Vasculopathy. American journal of ophthalmology, 156(3), 524-531.