Sir,
Choroidal effusions occur secondary to local changes such as hypotony, surgery, or inflammation. Primary uveal effusion may also occur with nanophthalmos or scleral abnormalities.1 Acute choroidal effusion has been described in association with local or systemic predisposing factors.2, 3, 4, 5, 6 We present a patient with acute, bilateral choroidal effusions related to an episode of vomiting alone.
A 64-year-old man presented with a 2-day history of painless visual loss in the left eye noticed the morning after an episode of vomiting. Other than type II diabetes mellitus, his past medical and ocular histories were unremarkable. Visual acuity with low myopic correction was 6/6 in the right eye and 6/36 in the left. Examination of the ocular adnexae, anterior segments, and intraocular pressure was normal. Dilated fundal examination revealed multiple, shallow choroidal effusions in the posterior pole and anterior to the equator of both eyes (Figures 1 and 2), involving the fovea in the left. There was no vitritis, retinitis, or vasculitis. B-mode ultrasonography confirmed shallow choroidal detachments with low internal reflectivity and no scleral thickening. Axial lengths (measured at presentation) were within normal limits (24 mm). A CT scan of the globes, fluorescein and indocyanine green angiography were unremarkable. Without treatment, his visual symptoms and signs resolved over 2 months and his corrected acuity returned to 6/6.
Acute choroidal detachments secondary to haemorrhage or effusion have been described previously. Many of these patients had known risk factors including impaired episcleral venous outflow, topical glaucoma therapy, prior ocular surgery, high myopia, or systemic anticoagulation.2, 3, 4, 5, 6 To our knowledge, there are only two published reports of acute choroidal detachment precipitated by Valsalva manoeuvre without other risk factors. Hammam and Madhavan7 described an acute rise in intraocular pressure following unilateral choroidal haemorrhage precipitated by straining during a bowel movement. Suan et al8 reported bilateral choroidal effusions occurring 3 days after prolonged vomiting. In our patient, lack of pain, low internal reflectivity, and the multifocal, bilateral nature point towards this being choroidal effusion rather than haemorrhage. Choroidal effusion can occur due to reduced trans-scleral movement of fluid, which may be secondary to scleral abnormality or, as in this case after Valsalva manoeuvre, raised intrathoracic pressure can increase back pressure in the venous drainage system.
References
Uyama M, Takahashi K, Koraki J, Tagami N, Takada Y, Okhuma H et al. Uveal effusion syndrome. Ophthalmology 2000; 107 (3): 441–449.
Akduman L, Del Priore LV, Kaplan HJ, Meredith T . Uveal effusion symdrome associated with primary pulmonary hypertension and vomiting. Am J Ophthalmol 1996; 121 (5): 578–580.
Mazzeo V, Galli G, Signori D, Perri P . Spontaneous choroidal detachment and red-eyed shunt syndrome: two clinical entities with the same cause? Int Ophthalmol 1985; 8 (3): 129–138.
Davani S, Delbosc B, Royer B, Kantelip J-P . Choroidal detachment induced by dorzolamide 20 years after cataract surgery. Br J Ophthalmol 2002; 86: 1457–1458.
Chak M, Williamson TH . Spontaneous suprachoroidal haemorrhage associated with high myopia and aspirin. Eye 2003; 17: 525–527.
Manuchehri K, Loo A, Ramachandani M, Kirby GR . Acute suprachoroidal haemorrhage in a patient treated with streptokinase for myocardial infarction. Eye 1999; 13 (3): 685–686.
Hammam T, Madhavan C . Spontaneous suprachoroidal haemorrhage following a valsalva manoeuvre. Eye 2003; 17: 261–262.
Suan EP, Rubsamen PE, Byrne SF . Bilateral ciliochoroidal detachments after Valsalva maneuver. Arch Ophthalmol 1993; 111: 304.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cuthbertson, F., McKibbin, M. Bilateral, multiple choroidal effusions after vomiting. Eye 19, 361–362 (2005). https://doi.org/10.1038/sj.eye.6701500
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.eye.6701500