Contributor: Gordon K. Klintworth
Hemorrhage in the choroid can be the result of several processes. It commonly follows penetrating wounds of eye and is sometimes caused by blunt trauma to the eye. Choroidal hemorrhage seldom develops spontaneously, but it may occur in the abscence of trauma as a complication of thrombocytopenia, hypotony or the Valsalva maneuver. Rarely it results from a choroidal melanoma [melanoma - choroid]. An accidental perforation of the globe through the cornea or corneoscleral limbus, perforated corneal ulcer or various surgical procedures with resulting hypotony can precipitate a choroidal hemorrhage. Surgical procedures that have resulted in choroidal hemorrhage include keratoplasty, cataract extraction with or without intraocular lens implantation, scleral buckling procedure, glaucoma filtering procedure and pars plana vitrectomy. Risk factors for operative and perioperative choroidal hemorrhage include glaucoma, an elevated intraocular pressure, increased axial length, atherosclerosis and an elevated intraoperative pulse. When severe a choroidal hemorrhage can cause an extrusion of the intraocular contents from the eye [hemorrhage - expulsive].The natural history of a choroidal hemorrhage is self-limited. When confined to the choroid the blood undergoes degradation and becomes resorbed. Particularly when prior trauma has occurred, the affected area becomes organized with granulation tissue and an ingrowth of fibroblasts and capillaries. An area of previous choroidal hemorrhage often contains abundant hemosiderin.