choroiditis

Choroiditis is inflammation of the choroid, the vascular layer of the eye located between the sclera and the retina. It is often considered a form of posterior uveitis and can occur in isolation or with inflammation in the neighboring uveal tissues. Choroiditis can be infectious or noninfectious and may present as focal, multifocal, or diffuse lesions that affect the outer retina and retinal pigment epithelium.

Signs and symptoms commonly include reduced or distorted central vision, blurred vision, floaters, and sometimes photophobia. Some patients notice blind spots (scotomas) or metamorphopsia. The severity and pattern of findings depend on the extent of choroidal involvement and may be accompanied by inflammatory signs in adjacent tissues.

Causes are diverse. Infectious etiologies include toxoplasmosis, tuberculosis, syphilis, histoplasmosis, and certain viral infections. Noninfectious, immune-mediated disorders such as sarcoidosis, Vogt-Koyanagi-Harada disease, birdshot chorioretinopathy, and Behçet disease can also involve the choroid. Choroiditis may occur as part of broader posterior uveitis or as a localized process.

Diagnosis relies on clinical examination supported by imaging and laboratory testing. Ophthalmic imaging (fundus photography, fluorescein angiography, optical coherence tomography, and sometimes indocyanine green angiography) helps characterize lesions and detect complications like macular edema or choroidal neovascularization. Laboratory testing targets potential infectious causes and underlying systemic diseases, guided by history and exam findings.

Treatment is cause-specific. Infectious choroiditis requires appropriate antimicrobial therapy and often adjunctive systemic or local anti-inflammatory treatment. Noninfectious choroiditis is typically managed with corticosteroids and immunosuppressive or biologic agents to control inflammation and prevent recurrences, with attention to potential systemic associations. Regular follow-up is important to monitor response and complications.

Prognosis varies; many patients stabilize or recover vision with timely, appropriate therapy, though scarring and recurrent flares can lead to lasting impairment.