Demographics:
85 year old African American female
Chief Complaint:
Poor vision in both eyes since falling down in the middle of the night one month ago
Medical History:
 Cardiac bypass surgery
 Stroke
 Hypertension
 Thyroidectomy
Systemic Medications:
 Aspirin, Plavix, Crestor, Synthroid, Isobride
Ocular History:
 Longstanding, severe glaucoma OU
 S/P bilateral trabeculectomies OU x 10 yrs
 Pseudophakia OU
Ocular Medications:
 Alphagan bid OU
 Lumigan qd OU
Vision:
20/40 OD; PH-NI
20/80 OS; PH-NI
IOP:
OD: 8 mmHg
OS: 8 mmHg
Typical IOP for patient: 8-10 mmHg OU
Pupils:
Irregular and fixed OU
Slit Lamp Findings:
 Shallow anterior chamber peripherally OD
 Posterior synchiae on superior nasal aspect of iris OD
 IOL capture and posterior synechiae OS (Figure 1)
 Psuedophakia OU
 Patent trabeculectomies and surgical peripheral iridectomies OD, OS with no
signs of leakage
Post Dilation:
Right intraocular implant moved forward and was partially dislodged into the
anterior chamber
Gonioscopy:
O.D. No structures visible 360 degrees
O.S. TM noted 360 degrees
Internal Examination:
360 degrees of annular, bilateral ciliochoroidal effusions with no evidence of
retinal breaks or tears (figures 2 and 3 on next slide)
Assessment:
Bilateral Annular Ciliochoroidal Effusions OU

Our patient most likely developed annular choroidal detachments from a combination
of having inflammation secondary to her trauma and a history of previous glaucoma
filtering surgery
 Her effusions caused the anterior rotation of the ciliary body-iris diaphragm and the
displacement of her right IOL into the anterior chamber
Plan:
 D/C Lumigan
 Rx: Homatropine TID OU
 Rx: Lotemax qhs OU
 Referral to retinal specialist for possible surgical intervention
Follow-Up
 After the dilating drops wore off, her right IOL implant did return completely to
the posterior chamber
Six months after her initial visit:
 The bilateral choroidal effusions have resolved
 Her glaucoma is managed only with Alphagan-P in the left eye and remains in 68mmHg range
 The right anterior chamber remains shallow and the angle is closed on gonioscopy
Discussion
Definition:
 Ciliochoroidal or uveal effusion is an abnormal accumulation of serous fluid from
the choroiocapillaris into the potential space between the sclera and the choroid or
ciliary body1,2
 The word effusion, by definition, means an escape of fluid into a tissue. Clinically,
the terms ciliochoroidal effusion and choroidal detachment are used
interchangeably throughout the literature.
Common Etiologies of Serous Detachments:
 Intraocular surgery
 Hypotony
 Inflammation
 Spontaneous-- typically occur in patients with unusually thick scleras or
nanophthalmos3
Symptoms:
 No symptoms
 Complain of decreased visual acuity
 Photophobia
 Pain
 Reduced peripheral vision
Clinical Characteristics of Ciliochoroidal Effusions
 Often times serous detachments are associated with hypotony and a flat anterior
chamber
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Ciliochoroidal effusions may occur with or without other associated ocular
abnormalities or systemic conditions
Effusions can be flat, lobular, or annular in nature
A smooth, solid appearance with no holes or tears will be noted on indirect
ophthalmoscopy
Typically appear yellowish-grey to orangish-brown in color
The pattern of choroidal vessels will be visible on the elevation
Visualization of the ora serrata and pars plana without scleral depression is usually
possible
Effusions almost always occur anterior to the vortex veins
Serous fluid found within the effusion is biochemically consistent with blood serum
Choroidal folds or linear streaks of RPE hypertrophy can occur after the effusion
resolves4
Differential Diagnosis
Diagnosis is usually confirmed with careful clinical observation and ultrasound.
Fluorescein angiography can also help differentiate serous choroidal detachments from
other suspicious lesions (table 1)
 Hemorrhagic Choroidal Detachment
 Malignant Melanoma
 Hemangioma
 Rhegmatogenous Retinal Detachment
 Non-rhegmatogenous Retinal Detachment
 Retinoschisis
Treatment of Ciliochoroidal Effusions
 Treatment depends on the etiology
 Uncomplicated effusions can resolve spontaneously without treatment or sequelae
 Cycloplegics (atropine or scopolamine t.i.d.) can be used to decrease blood vessel
permeability, retract the ciliary processes, and lessen ciliary spasm5
 Topical steroids (prednisolone acetate 1%) can be added if inflammation is present
or resolution doesn’t occur
 Systemic steroids (prednisone 20-80mg daily) may be necessary in severe or
refractory cases
 Surgical drainage of the serous fluid should be considered if the detachment persists
 Immediate surgical intervention is indicated when there is lens-cornea touch or IOLcornea touch exists6
Conclusion
 Visual outcome is unpredictable and pre-existing eye conditions (e.g. advanced
glaucoma) influence the final outcome7
 In the case of our patient, her intraocular implant was displaced partially into her
anterior chamber because the effusions caused her ciliary body to rotate around its
attachment to the scleral spur, shifting the lens/iris diaphragm forward6

Her angle is closed on gonioscopy in the right eye but her intraocular pressure
remains low because of a patent peripheral iridectomy
References
1. Brockhurst RJ. Ciliochoroidal (uveal) effusion. ch. 112. In: Ryan SJ, editor. Retina. St.
Louis: CV Mosby Year Book, 1994;2:1745-1752.
2.Torbit J. Ciliochoroidal Effusion. Clinical Vision and Vision Care. 1998; 10: 3-10.
3. Dunbar MT. Vision Loss Follows Hyperopia. Review of Optometry. 2006; 143:72-73.
4. Gass JDM. Stereoscopic atlas of macular diseases, diagnosis and treatment. 4th ed. St.
Louis: CV Mosby, 1997: 200-205
5. Pavlin CJ, Easterbrook M, Harasiewicz K, Foster FS. An ultrasound biomicroscopic
analysis of angle closure glaucoma secondary to ciliochoroidal effusion in IgA
nephropathy. Am J Ophthalmol, 1993:116(3):341-5.
6. Dugel PU, Heurer DK. Annular peripheral choroidal detachment simulating aqueous
misdirection after glaucoma surgery
7. Traverso CE. Choroidal Detachment. www.emedicine.com. 2005; 1-9