[Skip to Content]
[Skip to Content Landing]

Red Eye and Choroidal Detachment in an Older Woman

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A 64-year-old woman presented with diminution of vision, progressive redness, and dull aching pain in the right eye for 8 months. There was no history of trauma. Her medical history was unremarkable.

On examination, her best-corrected visual acuity measured 20/60 OD and 20/25 OS. The anterior segment showed dilated corkscrew conjunctival vessels (Figure 1), a shallow anterior chamber in the right eye, and nuclear cataract in both eyes. Pupillary reaction and color vision were normal in both eyes. Intraocular pressure was 16 mm Hg by Goldman applanation tonometry in both eyes. Gonioscopy revealed an occludable angle in the right eye without evidence of blood in the Schlemm canal. Both eyes’ extraocular movements were full and free in all directions of gaze. Dilated fundus examination showed a clear vitreous cavity in the right eye, 360° serous choroidal detachment partly obscuring the optic disc nasally (Figure 1), and the fundus in the left eye was unremarkable.

Please finish quiz first before checking answer.

You answered correctly!

Read the answer below and download your certificate.

You answered incorrectly.

Read the discussion below and retake the quiz.

A 64-year-old woman presented with diminution of vision, progressive redness, and dull aching pain in the right eye for 8 months. There was no history of trauma. Her medical history was unremarkable.

On examination, her best-corrected visual acuity measured 20/60 OD and 20/25 OS. The anterior segment showed dilated corkscrew conjunctival vessels (Figure 1), a shallow anterior chamber in the right eye, and nuclear cataract in both eyes. Pupillary reaction and color vision were normal in both eyes. Intraocular pressure was 16 mm Hg by Goldman applanation tonometry in both eyes. Gonioscopy revealed an occludable angle in the right eye without evidence of blood in the Schlemm canal. Both eyes’ extraocular movements were full and free in all directions of gaze. Dilated fundus examination showed a clear vitreous cavity in the right eye, 360° serous choroidal detachment partly obscuring the optic disc nasally (Figure 1), and the fundus in the left eye was unremarkable.

Survey Complete!

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Muna Bhende, MS, Shri Bhagwan Mahavir Vitreoretinal Service, Medical Research Foundation, Nethralaya, 41 College Rd, Nungambakkam, Chennai 600006, Tamil Nadu, India (drmuna@snmail.org).

Published Online: May 18, 2023. doi:10.1001/jamaophthalmol.2023.1513

Correction: This article was corrected on June 8, 2023, to delete the corresponding author’s middle initial.

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information. We also thank Ambika Selvakumar, MD, Department of Neuro-Ophthalmology, Medical Research Foundation, and Swatee Halbe, MD, Apollo Specialty Hospitals.

References
1.
Henderson  AD , Miller  NR .  Carotid-cavernous fistula: current concepts in aetiology, investigation, and management.   Eye (Lond). 2018;32(2):164-172. doi:10.1038/eye.2017.240PubMedGoogle ScholarCrossref
2.
Barrow  DL , Spector  RH , Braun  IF , Landman  JA , Tindall  SC , Tindall  GT .  Classification and treatment of spontaneous carotid-cavernous sinus fistulas.   J Neurosurg. 1985;62(2):248-256. doi:10.3171/jns.1985.62.2.0248PubMedGoogle ScholarCrossref
3.
Slusher  MM , Lennington  BR , Weaver  RG , Davis  CHJ  Jr .  Ophthalmic findings in dural arteriovenous shunts.   Ophthalmology. 1979;86(5):720-731. doi:10.1016/S0161-6420(79)35454-9PubMedGoogle ScholarCrossref
4.
Berk  AT , Ada  E , Kir  E , Saatci  AO .  Choroidal detachment associated with direct spontaneous carotid-cavernous sinus fistula.   Ophthalmologica. 1997;211(1):53-55. doi:10.1159/000310875PubMedGoogle ScholarCrossref
5.
Komiyama  M , Nishikawa  M , Yasui  T .  Choroidal detachment and dural carotid-cavernous sinus fistula–case report.   Neurol Med Chir (Tokyo). 1997;37(6):459-463. doi:10.2176/nmc.37.459PubMedGoogle ScholarCrossref
6.
Texakalidis  P , Tzoumas  A , Xenos  D , Rivet  DJ , Reavey-Cantwell  J .  Carotid cavernous fistula (CCF) treatment approaches: a systematic literature review and meta-analysis of transarterial and transvenous embolization for direct and indirect CCFs.   Clin Neurol Neurosurg. 2021;204:106601. doi:10.1016/j.clineuro.2021.106601PubMedGoogle ScholarCrossref
7.
Jamison  A , Siddiqui  A , Lockington  D .  Persistent red eye unresponsive to topical treatment.   JAMA Ophthalmol. 2021;139(1):119-120. doi:10.1001/jamaophthalmol.2020.4062PubMedGoogle ScholarCrossref
8.
Gemmete  JJ , Chaudhary  N , Pandey  A , Ansari  S .  Treatment of carotid cavernous fistulas.   Curr Treat Options Neurol. 2010;12(1):43-53. doi:10.1007/s11940-009-0051-3PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Close
Close

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close