Diagnostic Challenges of Choroidal Rupture: A Case Report

Abstract

Background: A choroidal rupture is a break in the choroid, Bruch membrane, and the retinal pigment epithelium, leaving the overlying neurosensory retina intact. It is usually a result of a traumatic injury to the globe. Depending on the trauma mechanism choroidal rupture can be located at the peripheral fundus or at the posterior pole. Symptoms are based on the location of the rupture and may vary from asymptomatic if the rupture does not involve the fovea or parafoveal retina, to significantly reduced vision if those structures are involved. Case report: A 29-year-old male presented to the Emergency department (ED) with decreased visual acuity to hand motion after sustaining a blunt trauma to his left eye. During the examination, insignificant hemophthalmus and subretinal hemorrhage size of 4 optic nerve discs at the superior vascular arcade was observed. Tonometry showed normal values. The patient was diagnosed with left eyeball contusion, retinal commotion, and subretinal hemorrhage and discharged after being recommended cold compressions to the left eye and non-steroid anti-inflammatory drug (NSAID) therapy. One month later the patient was reevaluated due to persistent visual acuity loss in the left eye. Visual acuity in the left eye was 0.1, blood from the subretinal hemorrhage was reabsorbed and new findings were observed - vitreous detachment at the posterior pole, retinal commotion area covering all macula as well as a choroidal tear in the posterior pole crossing the central part of the macula. Ultrasound of the left eye revealed thickened chorioretinal layer with possible retinal swelling, no retinal or choroidal detachment was observed. Without any indications for surgical treatment, NSAID therapy was continued to treat damaged retina. Conclusions: When the choriocapillaris is injured during an ocular trauma, bleeding into the subretinal pigment epithelium or subretinal space occurs. Such hemorrhage may initially mask the choroidal rupture, as in this case. Although there is no surgical treatment available for choroidal rupture, follow-up of one to two times per year is important to screen for complications such as choroidal neovascularization, which requires specific treatment of anti-VEGF injections. A choroidal rupture by itself does not heal over time and since this patient experienced subfoveal choroidal rupture his visual acuity prognosis is poor.