Choroidal folds
 

There are horizontal lines (sometimes these lines may be oblique or vertical) on the posterior pole of the eye. Choroidal folds may be idiopathic but in the examination you need to show the examiner(s) that you know  the possible association. Further examination include: checking the affected for proptosis  presence of subretinal fluid may suggest posterior scleritis

Questions:

1. What are the causes of choroidal folds?

Answer
idiopathic
orbital tumour such as glioma or meningioma
thyroid eye disease
posterior scleritis
hypotony

2. The following is the fluorescein angiography of a patient with choroidal folds. Which parts of the folds (ie crest or trough) are responsible for the lines of  hypofluroescence and hyperfluorescence respectively?
 

Answer
In the troughs of the choridal folds, the RPE cells are compressed and therefore RPE becomes a more efficient filter and they are represented by hypofluorescence lines. At the crest, the choroid and RPE are stretched and hence the effect of RPE as filter is reduced making the crest hyperfluorescence.

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