Diffuse choroidal thickness in a patient with migraine headaches

History of present illness

A 28-year-old female patient was referred by the outside retina practice for evaluation of a possible mass lesion in the left eye. The patient reported occasional headaches and pressure sensation without any systemic manifestation. The ocular mass lesion was initially detected on a computed tomography (CT) scan for the assessment of migraine headaches. Although the CT scan was negative for brain masses or lesions, it showed a 1.3 cm × 0.7 cm × 0.5 cm ovoid, well-circumscribed homogeneous mass in the left posterior upper aspect of the globe ( Fig. 70.1 ). In addition, ocular melanoma and ocular metastasis were ruled out by a radiologist. Ocular history included mildly decreased vision in the left eye since childhood, without any recent acute vision changes. The patient had a medical history of migraine headaches, medically controlled hypertension, and glaucoma. There was no medical history of trauma, cancer, or infectious, inflammatory, or autoimmune conditions. She had no known drug allergies and was not taking any medications except a brimonidine eye drop in her left eye and medication for controlling hypertension. Reviews of systems and family and social history were unremarkable.

Fig. 70.1

Computed tomography scan of the brain without contrast demonstrating a 1.3 cm × 0.7 cm × 0.5 cm ovoid, well-circumscribed homogeneous mass in the left posterior upper aspect of the globe.

Questions to ask

  • What is the result of the ocular examination?

  • What is the result of spectral domain optical coherence tomography (SD-OCT) and B-scan?

  • Does the patient have any history of facial hemangioma?


On ocular examination, the best-corrected visual acuity was 20/20 in the right eye and 20/60 in the left eye, with an element of amblyopia, but without any improvement with refraction. Extraocular movements were intact, the pupils were round and reactive, and there was a relative afferent pupillary defect only in the left eye. The refraction in the right eye was −4.00, whereas in the left eye it was +1.50, +2.00 × 90. Intraocular pressure by applanation was 14 mm Hg in the right eye and 24 mm Hg in the left eye while the patient was on brimonidine eye drop for her left eye. Visual field was full. Anterior and posterior segment examinations were unremarkable except for dilated episcleral vessels ( Fig. 70.2 A), glaucomatous optic nerve ( Fig. 70.2 B), and alteration of choroidal color in the left eye.

Fig. 70.2

Retinal nerve fiber layer analysis of both eyes. Color fundus photographs of (A) the right eye and (B) the left eye. (C) B-scan photograph of the left eye demonstrating diffuse choroidal thickening with moderate homogeneity. (D) Spectral-domain optical coherence tomography image of the macula in the left eye.

Differential diagnosis

The differential diagnosis for ill-defined diffuse choroidal thickening includes choroidal melanoma, choroidal metastasis, choroidal osteoma, choroidal hemangioma, posterior uveitis, central serous chorioretinopathy, Vogt-Koyanagi-Harada syndrome, and hypotony maculopathy/retinopathy ( Fig. 70.3 ).

Jun 15, 2024 | Posted by in OPHTHALMOLOGY | Comments Off on Diffuse choroidal thickness in a patient with migraine headaches

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