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

• Chorioretinal Folds
• Retina-Choroidal Folds

What is Choroidal Folds? (Definition/Background Information)

• Choroidal Folds is defined as the presence of parallel grooves that involves the Bruch’s membrane. The Bruch’s membrane is part of the eye and is the innermost choroidal layer. The folds are visible on an examination by a healthcare provider, using a fundoscope (specialized medical instrument)
• The choroid is a portion of the uvea (part of the eye structure) that is predominantly made up of the blood vessels. The choroid provides nutrients to the retina keeping it healthy
• If the retina is also involved i.e., grooves are noted in both the Bruch’s membrane and the retinal pigment epithelium (RPE), then the condition is known as Chorioretinal Folds
• A variety of causes have been attributed to Choroidal Folds which include tumor of the eye, chronic swelling of the optic disc, surgery to the eye, and inflammation of the sclera (part of the eye structure). In some cases, the cause remains unknown (idiopathic)
• In many cases, no significant signs and symptoms due to Choroidal Folds may be observed. In some individuals, a sudden onset of signs and symptoms including vision defects may be seen
• A healthcare provider can use various physical (eye) exams, fundoscopic, and angiographic studies to diagnose Choroidal Folds. The treatment choice depends upon the underlying cause of the condition
• The prognosis for Choroidal Folds depends on the underlying condition and severity of the signs and symptoms. An early diagnosis and appropriate treatment can result in a good prognosis

Who gets Choroidal Folds? (Age and Sex Distribution)

• Choroidal Folds can present itself at any age, but is more likely to occur in adults
• Both males and females are affected
• Individuals of different racial and ethnic backgrounds can be affected

What are the Risk Factors for Choroidal Folds? (Predisposing Factors)

The risk factors for Choroidal Folds may include the following conditions:

• Tumors affecting the eye
• Any condition that results in increased intracerebral pressure in the eye
• Medical (surgical) procedures involving the eye
• Conditions causing eye inflammation
• Conditions affecting the retina

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 Folds? (Etiology)

Choroidal Folds is an eye condition that may be caused by several conditions, which include:

• Eye and eye orbital tumors that include choroidal tumor, orbital tumor, orbital inflammatory pseudotumor, parasellar tumor (tumor in a region of the brain), etc.
• Carotid-cavernous fistula (CCF), which is an abnormal connection between the carotid artery and the cavernous sinus in the skull
• Retinal conditions such as central serous retinopathy, retinal detachment, chorioretinal scar, retinal vein occlusion
• Inflammation of various eye parts:
  • Inflammation of the sclera (eye white) due to posterior scleritis
  • Inflammation of the uvea (uveitis)
  • Inflammation of the choroid (choroiditis)
  • Optic nerve inflammation (or optic neuritis)
  • Eye tissue inflammation (or orbital cellulitis)
• Choroidal neovascularization (CNV): An abnormal development of blood vessels in the choroid
• Optic disc swelling caused by a disorder known as chronic papilledema
• Farsightedness (acquired) or hyperopia
• Low muscle tone or hypotonia
• Thyroid eye disease (or thyroid ophthalmopathy)
• Microphthalmia (or abnormally small eyes) due to a developmental defect/disorder
• Uveal effusion syndrome, a rare condition affecting the choroid and retina
• Orbital mucocele (or mucus cyst)
• Certain medications may cause the condition (drug-induced cause)
• Sinusitis or inflammation of the sinus cavity
• Iatrogenic factors including eye surgery (such as for cataract or retinal detachment), or post-procedure eye inflammation, or laser therapy

In many cases, the cause may be unknown or unidentified (termed Idiopathic Choroidal Folds).

What are the Signs and Symptoms of Choroidal Folds?

The signs and symptoms depend upon the underlying condition/disorder causing Choroidal Folds and may include a wide-range of presentations.

• Sudden onset of symptoms and vision abnormalities is observed in some individuals
• In many, there may not be any significant signs and symptoms and the condition could go undiagnosed
• Vision defects due to Choroidal Folds may include reduced vision, light-sensitivity, blind spots in the eye, light flash sensation, and blurred vision
• There may be pain associated with the condition, but it depends upon the underlying cause
• The condition can be unilateral or bilateral and one/both eyes may be affected

How is Choroidal Folds Diagnosed?

A healthcare professional may diagnose Choroidal Folds 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): Generally, a fundoscopic examination may reveal an abnormal finding, which can help diagnose the condition. Choroidal Folds is not an ‘uncommon’ incidental finding when an eye specialist examines the eye
• 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)
• Rarely, a biopsy of the choroid may be performed to help with the diagnosis
• Other tests to determine any underlying condition causing Choroidal Folds

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 Folds?

Complications of Choroidal Folds are dependent upon the underlying condition/disorder/tumor causing it. Choroidal Folds 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
• Edema of the eye (or the presence of fluid in the eye)
• Glaucoma: A condition that can cause blindness due to higher intraocular pressure
• Cataracts: When the lens of the eye becomes clouded and cause vision loss
• Retinal detachment: An eye condition wherein the retina gets separated from the eye structures that holds the retinal layers together
• If left undiagnosed and/or untreated, the condition can lead to permanent blindness
• Kidney damage, high blood sugar, and high blood pressure due to steroid treatment

How is Choroidal Folds Treated?

Early diagnosis and treatment of Choroidal Folds is very crucial in preventing complications that may result in irreversible damage to the eye. The treatment of Choroidal Folds may include the following measures:

• Addressing the underlying condition that may be causing or contributing to progression of the disorder is very important
• Oral medications (including pain medications)
• Oral corticosteroids may be given to control inflammation. Steroids may also be administered intravenously depending on the underlying cause
• Dark glasses may be prescribed for light-sensitivity
• If the underlying cause is unknown, then decreasing inflammation is the main step towards treating Choroidal Folds
• Administration of immunomodulators, which are medications to control dysfunctional immune system
• If choroidal neovascularization is observed, then laser therapy may be helpful

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 Folds be Prevented?

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

• Regular and periodic eye examination to assess eye health
• 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)
• Treating any underlying condition that can cause harm to the eye, as early as possible
• Maintaining long-term follow-up checkups

What is the prognosis of Choroidal Folds? (Outcomes/Resolutions)

• The prognosis of Choroidal Folds, most importantly, depends on the underlying cause of the condition. It also depends upon the severity of the signs and symptoms
• If the underlying cause of Choroidal Folds can be treated or controlled, then the outcomes are generally better than when the condition cannot be treated

Additional and Relevant Useful Information for Choroidal Folds:

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

http://www.dovemed.com/health-topics/vision-center/