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.
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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