NEWS & EVENTS
Retinal Review, Issue 29
CASE NUMBER 29
A 46 year old man was referred for maculopathy in his right eye. He underwent a routine complete eye examination with his optometrist the week before and was noted to have wrinkling in his macula. He was asymptomatic. Past medical history is significant for lymphoma for which he underwent chemotherapy five years before. Past ocular history is negative. On examination, visual acuity was 20/20 OU. IOP’s were normal. There was no proptosis in either eye or orbital signs. The slit lamp examination was normal. Dilated examination revealed a clear lens and vitreous OU. The left fundus was completely normal. Macular folds were noted in the right eye. OCT nicely demonstrated the choroidal and RPE folds in the right eye with a normal overlying retina. The OCT of the left eye was normal. A bscan was performed to look for evidence of globe malformation or retroocular mass. The bscan was unremarkable.
Given the patient’s medical history, our primary concern was an orbital lesion with pressure against the back of the globe and secondary choroidal folds. This was unlikely because we would have expected proptosis, orbital findings (reduced eye movements, retropulsion, increased IOP in certain aspects of gaze, lid alteration), and a hyperopic shift. The patient had none of the above. Nevertheless, we felt that it was important to rule this out and sent the patient for an MRI of the orbits. Fortunately the results were normal.
The patient was diagnosed with idiopathic choroidal folds. This is an uncommon but well documented condition which is almost always bilateral. Despite the dramatic fundus appearance, the vision is usually completely normal. No treatment is indicated in that it is a benign condition. Our case was unusual because the folds were unilateral. If the folds had been bilateral we likely would not have ordered the MRI. We reassured the patient that his condition was benign and that he could have routine ocular follow up.