Case Study 17 Idiopathic Choroidal Folds

Abstract

PR is a 26-year-old man who noted some blurring of the vision in his right eye and scheduled an evaluation by his optometrist. Examination found vision 20/25 OD and 20/15 OS. There was mild distortion of the vision in the OD to Amsler grid testing. The slit-lamp examination was unremarkable, but the fundus examination showed moderate choroidal folds in the right eye. An orbital tumor was suspected, and the patient underwent CT scanning that did not demonstrate a mass and was reported as normal. The patient sought a second opinion from the oculoplastic service at the university medical center.

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PR is a 26-year-old man who noted some blurring of the vision in his right eye and scheduled an evaluation by his optometrist. Examination found vision 20/25 OD and 20/15 OS. There was mild distortion of the vision in the OD to Amsler grid testing. The slit-lamp examination was unremarkable, but the fundus examination showed moderate choroidal folds in the right eye. An orbital tumor was suspected, and the patient underwent CT scanning that did not demonstrate a mass and was reported as normal. The patient sought a second opinion from the oculoplastic service at the university medical center.

Ultrasound was performed, and no orbital mass was detected by either A- or B-scan. However, there was some subtle flattening of the globe consistent with idiopathic choroidal folds (Fig. 1).

Fig. 1

B-scan of flattening of posterior globe wall (arrows)

However, choroidal folds can be the result of compression of the posterior wall of the globe by an orbital mass. Such lesions can be detected and characterized at the time of the initial examination with timely referral of the patient for directed follow-up studies and optimal management by a specialist.