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.

Figure 1
figure 1

Small choroidal effusion affecting the posterior pole of the right eye.

Full size image
Figure 2
figure 2

Larger choroidal effusions seen at the posterior pole of the more symptomatic left eye.

Full size image

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.