When the eye is compressed along its anterior–posterior axis, tears may occur in Bruch membrane, which has little elasticity, as well as in the overlying RPE and fibrous tissue around the choriocapillaris. Adjacent subretinal hemorrhage is common. Choroidal ruptures may be single or multiple and occur typically in the periphery and concentric to the optic nerve head (Fig 18-2). Ruptures that extend through the fovea may cause permanent vision loss. There is no effective treatment.
Figure 18-2 Color fundus photograph from a patient with a posttraumatic submacular hemorrhage. The hemorrhage started to clear, revealing a choroidal rupture (arrow). The yellow material located at the inferonasal portion of the macula (arrowhead) is dehemoglobinized blood.
(Courtesy of Mark Johnson, MD.)
Occasionally, choroidal neovascularization (CNV) develops as a late complication after damage to Bruch membrane (Fig 18-3). A patient with a choroidal rupture near the macula should be alerted to the risk of CNV. Subfoveal CNV, if present, is generally treated with a vascular endothelial growth factor (VEGF) inhibitor. See Chapter 4 of this volume for information on the management of CNV.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.