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Choroiditis – Causes, Symptoms and Treatment

Choroiditis is an inflammation of the choroid, a vascular layer at the back of the eye. It can threaten vision and requires prompt medical evaluation.

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Things worth knowing about "Choroiditis"

Choroiditis is an inflammation of the choroid, a vascular layer at the back of the eye. It can threaten vision and requires prompt medical evaluation.

What is Choroiditis?

Choroiditis is an inflammation of the choroid – the highly vascularized layer of the eye located between the retina and the sclera (the white outer coat of the eye). The choroid supplies the outer layers of the retina with oxygen and essential nutrients. When inflamed, it can significantly impair visual function and requires immediate ophthalmological assessment.

Choroiditis often occurs alongside retinal inflammation, a condition known as chorioretinitis. When the ciliary body and iris are also involved, the condition may be classified as posterior uveitis or panuveitis, depending on the extent of involvement.

Causes

Choroiditis can be caused by infectious or non-infectious factors:

Infectious Causes

Toxoplasmosis: The most common infectious cause worldwide, caused by the parasite Toxoplasma gondii
Tuberculosis: Infection with Mycobacterium tuberculosis
Syphilis: Bacterial infection caused by Treponema pallidum
Cytomegalovirus (CMV): Especially in immunocompromised individuals
Herpesviruses: Including herpes simplex and varicella-zoster virus
Fungal infections: Such as Candida, particularly in immunosuppressed patients

Non-Infectious Causes

Autoimmune diseases such as sarcoidosis, Behcet disease, or systemic lupus erythematosus
Inflammatory bowel diseases (e.g., Crohn disease, ulcerative colitis)
Idiopathic causes (no identifiable trigger)

Symptoms

Symptoms of choroiditis can vary considerably depending on the severity and location of the inflammation. Common symptoms include:

Blurred vision or partial/total vision loss
Light sensitivity (photophobia)
Floaters: Perception of spots, threads, or shadows in the visual field
Distorted vision (metamorphopsia) when the macula is involved
Little to no pain in many cases, as the choroid itself has limited pain sensitivity

If the inflammation occurs near the macula – the area of sharpest central vision – a significant drop in visual acuity may occur.

Diagnosis

Diagnosis is typically made by an ophthalmologist using a combination of the following examinations:

Slit-lamp examination: Assessment of anterior and posterior eye segments
Ophthalmoscopy (funduscopy): Direct visualization of the fundus
Fluorescein angiography: Imaging of choroidal vessels using contrast dye
Optical coherence tomography (OCT): High-resolution cross-sectional imaging of retinal and choroidal layers
Laboratory tests and serology: To identify infectious or autoimmune causes

Treatment

Treatment depends on the underlying cause:

Infectious Choroiditis

Toxoplasmosis: Combination of pyrimethamine, sulfadiazine, and folinic acid
Tuberculosis: Anti-tuberculosis combination therapy
Syphilis: Intravenous penicillin
Viral infections: Antiviral agents such as ganciclovir or aciclovir

Non-Infectious Choroiditis

Corticosteroids (topical, periocular, or systemic) to reduce inflammation
Immunosuppressants for severe or recurrent cases (e.g., methotrexate, mycophenolate mofetil)
Biologics for autoimmune-related cases that are refractory to standard therapy

Regular follow-up with an ophthalmologist is essential to monitor treatment response and detect complications such as macular edema, retinal detachment, or secondary glaucoma at an early stage.

References

Pleyer U., Forrester J.V. (eds.) – Uveitis and Immunological Disorders. Springer, 2007.
Jabs D.A., Nussenblatt R.B., Rosenbaum J.T. – Standardization of Uveitis Nomenclature (SUN) Working Group. American Journal of Ophthalmology, 2005.
American Academy of Ophthalmology (AAO) – Uveitis: Clinical Guidelines and Practice Patterns. AAO, 2023. Available at: https://www.aao.org

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