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Choroidal detachment

Choroidal detachment is evaluated when there is a history of trauma, surgery, acute pressure changes, or inflammation causing fluid or hemorrhage in the suprachoroidal space, often presenting with visual symptoms or as an incidental finding on imaging.

Key Images

Types of detachment

Types of detachment

Serous Choroidal Detachment

Hemorrhagic Choroidal Detachment

Hemorrhagic Choroidal detachment - traumatic

Hemorrhagic Choroidal detachment

Look For First
  • Paired convex echogenic or hypodense bands extending posteriorly from the ciliary bodies on ultrasound, CT, or MRI
  • Detachment that extends anteriorly beyond the ora serrata, distinguishing it from retinal detachment which is limited by the ora serrata
  • Posterior divergence of the detachment as it approaches the optic disc at the level of vortex vein insertion, contrasting with retinal detachment convergence
Key Image Findings
  • On ultrasound: paired convex echogenic bands that remain fixed during eye movements, extending posteriorly from ciliary bodies to insertion points at the vortex veins, with anterior extension beyond the ora serrata
  • On CT: choroidal effusions appear as hypodense convex fluid collections elevating a relatively hyperdense choroid, while choroidal hemorrhage appears as a hyperdense lentiform lesion
  • On MRI: choroidal effusions show low T1 and high T2 signal intensity in the suprachoroidal space, while choroidal hemorrhage is typically hyperintense on T1 and hypointense on T2 depending on blood age
  • The posterior points of attachment are distal to the optic disc at the level of vortex vein insertion where the sclera and choroid are tightly adherent
  • Fixed position during eye movements helps differentiate choroidal detachment from retinal detachment and posterior vitreous detachment which are mobile
  • The detachment is bounded anteriorly by extension beyond the ora serrata and posteriorly by divergence rather than convergence at the optic disc
  • Choroidal effusion is transudative in trauma or exudative in inflammation, while choroidal hemorrhage results from rupture of small choroidal vessels in trauma and surgery
  • Heterogeneous signal on MRI may occur with choroidal hemorrhage depending on the age and evolution of the blood products
Differential Diagnosis
  • Retinal detachment: key distinguishing feature is anterior limitation by the ora serrata and posterior convergence to the optic disc, as opposed to choroidal detachment which extends beyond the ora serrata anteriorly and diverges posteriorly
  • Posterior vitreous detachment: distinguished by mobility during eye movements, whereas choroidal detachment remains fixed in position
  • Choroidal melanoma: can present as a mass but lacks the characteristic paired convex bands and bilateral appearance common in choroidal detachment
  • Glaucoma: may be a predisposing condition but is not a structural mimicker; elevated IOP can cause choroidal detachment
  • Metastatic tumor: can cause choroidal detachment secondarily but typically presents as a discrete mass rather than paired detached membranes
Discussion

Choroidal detachment results from accumulation of fluid in the suprachoroidal space due to elevated intraocular pressure, which can be transudative (non-hemorrhagic) or hemorrhagic depending on vessel rupture

The most common etiologies include trauma, surgery, spontaneous Valsalva maneuver, inflammatory conditions like uveitis, ocular neoplasms, and medications affecting IOP regulation

The characteristic paired convex bands with posterior divergence pattern on imaging reliably distinguishes choroidal detachment from the convergent pattern of retinal detachment

Untreated or inadequately treated choroidal detachment can cause serious complications including corneal damage and cataracts

Management depends on etiology: non-traumatic cases are treated with IOP-lowering medications and treatment of the underlying cause, while traumatic cases may require surgical intervention

High-frequency ultrasound through the closed eyelid provides excellent anatomic detail and is often the preferred initial imaging modality, while CT and MRI are reserved for evaluating underlying causes such as metastasis

Reporting Pearls

Describe choroidal detachment as paired convex fluid or hemorrhagic collections in the suprachoroidal space that extend anteriorly beyond the ora serrata and diverge posteriorly at the vortex vein insertion points distal to the optic disc, specifying whether the content is effusive (low density/signal) or hemorrhagic (high density/signal) based on imaging characteristics.

Pitfalls
  • Misidentifying choroidal detachment as retinal detachment by overlooking the anterior extent beyond the ora serrata and posterior divergence pattern rather than convergence
  • Failing to assess for fixity during eye movements on ultrasound, which is a key feature distinguishing choroidal detachment from mobile posterior vitreous detachment
  • Assuming all choroidal detachments are traumatic in origin when non-traumatic causes such as inflammatory, neoplastic, or hypertensive etiologies must be considered
  • Neglecting to evaluate for serious underlying causes such as ocular neoplasm, metastasis, or severe inflammation that may require treatment beyond IOP management
Source: Reference source