Gaurav K. Shah

BASICS

DESCRIPTION

• Parallel striae that may be oriented in a horizontal, vertical, or oblique fashion at the posterior pole. (1)

• Not a condition, but rather a clinical finding that may be idiopathic or secondary to another underlying ocular or orbital etiology

EPIDEMIOLOGY

Unknown

RISK FACTORS

See Etiology.

PATHOPHYSIOLOGY

• Wrinkling of the retinal pigment epithelium, Bruch’s membrane, and the inner choroid layers

• The lighter colored peaks of the folds are thought to be created by stretching and thinning of the overlying retinal pigment epithelium (RPE), and the darker troughs represent compression of the RPE. However, histopathologic studies have challenged this notion.

• Thought to occur because of an imbalance between the contractile and stretching forces affecting the eye wall (2)

– Intraocular forces: For example, hypotony

– External forces: For example, orbital mass lesions, papilledema (increased cerebrospinal fluid pressure transmitted to the eye wall)

– Direct tractional effect: For example, choroidal neovascular membranes

ETIOLOGY

• Most often, choroidal folds are idiopathic. However, a secondary etiology may be present.

• Ocular conditions

– Choroidal nevi and tumors

– Choroidal neovascularization

– Choroidal inflammation

– Choroidal detachment or effusions.

– Central serous chorioretinopathy

– Hypotony

– Posterior scleritis

– Vogt-Koyanagi-Harada syndrome

– Hyperopia

– Scleral buckle

• Optic neuropathies

– Papilledema

– Optic nerve tumors

• Orbital conditions

– Orbital tumors

– Orbital inflammation

– Thyroid orbitopathy

• Increased intracranial pressure (ICP)

– Has been shown to cause choroidal folds, independent of the presence of papilledema

DIAGNOSIS

HISTORY

May be asymptomatic, however, patients may complain of a variety of visual disturbances including blurring of vision or metamorphopsia

PHYSICAL EXAM

• Choroidal folds are a clinical finding seen on dilated funduscopy of the posterior pole. They appear as parallel lines of lighter (yellow) colored peaks alternating with darker (orange) colored troughs.

• A thorough external, anterior, and posterior segment examination, along with measurement of intraocular pressure, should be performed on all patients with choroidal folds, as this may provide clues to an underlying etiology.

DIAGNOSTIC TESTS & INTERPRETATION

Imaging

• Fluorescein angiography (FA) can be useful in demonstrating choroidal folds.

– A characteristic dark-light alternating pattern of hypo- and hyper- fluorescence is seen, which represents compression and stretching of the RPE, respectively.

– This test can help differentiate choroidal folds from retinal folds, as the latter will not show alterations in background fluorescence.

– FA may also help to elucidate an underlying etiology.

• Optical coherence tomography has also been demonstrated to be a useful imaging modality for this condition, especially for differentiating choroidal folds from retinal folds and chorioretinal folds. (3)

• Fundus autofluorescence may also demonstrate characteristics. (4)

Diagnostic Procedures/Other

• Orbital imaging may be indicated in patients with choroidal folds to determine an underlying etiology. This may include:

– B-Scan ultrasonography of the eye and orbit

– CT of the orbits and brain

– MRI of the orbits and brain (5)

TREATMENT

MEDICATION

• Treatment of choroidal folds is targeted toward the underlying etiology.

• Asymptomatic, idiopathic choroidal folds may be observed.

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Serial fundus examinations

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