Logo Specialty Vision Horizontal White
Icon Specialty Vision Fullcolor1

Choroidal hemangioma is a benign vascular tumor that can lead to significant vision issues if left unmonitored. Our experienced retina specialists are here to ensure your ocular health and provide effective management of this condition.

Table of Contents

Choroidal Hemangioma: Comprehensive Guide & Definition and Overview & Types of Choroidal Hemangioma & Circumscribed Choroidal Hemangioma (CCH) & Diffuse Choroidal Hemangioma (DCH)

Choroidal hemangioma is a rare, benign vascular tumor that forms in the choroid, the vital layer of blood vessels between the retina and sclera. It is important to understand this condition because, although non-malignant, its presence can lead to serious vision issues if left unmonitored. Our retina specialists are dedicated to ensuring that any issues related to choroidal hemangioma are promptly and effectively managed.

This condition is essentially a collection of abnormal blood vessels that appear as an orange-red or reddish-orange mass in the back of the eye. There are two main types of choroidal hemangioma:

  • Circumscribed Choroidal Hemangioma (CCH): These are typically solitary lesions that occur without any associated systemic diseases. They are most commonly seen in adults aged between 30 and 50 years.
  • Diffuse Choroidal Hemangioma (DCH): These lesions tend to involve a broader area of the choroid and are often linked with Sturge-Weber syndrome—a neurocutaneous disorder that can also present with neurological and skin manifestations during childhood.

Although these tumors are benign, meaning they do not spread to other parts of the body, they can cause complications that affect vision. The abnormal vessels may leak fluid, which can lead to retinal detachment or an accumulation of subretinal fluid. This, in turn, could progressively disturb the normal function of the retina, the layer responsible for converting light into neural signals that the brain interprets as images.

Circumscribed choroidal hemangiomas tend to be isolated lesions that appear as a dome-shaped mass located in the posterior pole of the eye, the central area crucial for fine vision. Typically, they are unilateral, meaning only one eye is affected. As these tumors develop gradually, patients may experience a slow decline in vision, often due to the following complications:

  • Macular involvement: When the tumor impacts the macula—the central part of the retina—it can disturb sharp, detailed vision.
  • Subretinal fluid accumulation: Leakage from the abnormal vessels can lead to a buildup of fluid beneath the retina, further blurring vision.
  • Retinal pigment epithelium (RPE) changes: The RPE is a layer of cells that supports the retina, and its alteration can compromise retinal health over time.

Because of these potential complications, our retina specialists emphasize the importance of monitoring any changes in vision, especially in patients between 30 and 50 years of age who are statistically more likely to experience this form of the tumor.

Diffuse choroidal hemangiomas present a different set of challenges compared to circumscribed types. These tumors spread over a more extensive area of the choroid, often affecting a significant portion of the posterior eye. DCH is most commonly associated with Sturge-Weber syndrome, a condition that not only affects the eyes but also has neurological and cutaneous manifestations. Patients with this syndrome might also present with:

  • Port-wine stains: These are discolored facial marks, generally along the region served by the V1 dermatome (the area around the eye).
  • Glaucoma: Increased pressure in the eye is a common occurrence, which further complicates the overall ocular health.
  • Neurological issues: In some cases, seizures and other neurological involvement indicate the need for a comprehensive, multidisciplinary approach to care.

The widespread involvement in DCH makes treatment more challenging, as both the ocular condition and any systemic manifestations need to be managed concurrently. This complexity underscores why our retina specialists might recommend a broader medical evaluation alongside routine eye examinations.

Vision Impact and Early Recognition & Importance of Early Recognition & Visual Complications & Diagnosis and Imaging & Diagnostic Approach

Here’s the thing: timely recognition of choroidal hemangioma is essential to prevent further complications. Even though the tumor itself is non-cancerous, the resulting leakage and accumulation of fluid can significantly threaten your vision. Early detection allows our retina specialists to provide treatments that can stabilize the condition before significant damage occurs.

The main concern with choroidal hemangioma is its impact on your vision. The abnormal blood vessels allow fluid to seep into areas where it shouldn’t be, leading to two primary complications:

  • Exudative retinal detachment: Fluid accumulation can cause the retina to detach from its supportive layers, creating a situation that threatens sight.
  • Chronic subretinal fluid: Persistent fluid beneath the retina can result in tissue changes and permanent damage if not treated promptly.

Even though these complications might not cause discomfort initially, the gradual decline in visual acuity can have a significant impact on daily activities. That’s why early detection and intervention are so critical.

Early and accurate diagnosis is key in managing choroidal hemangioma. Our retina specialists rely on a combination of clinical examination and advanced imaging techniques to differentiate between the circumscribed and diffuse types. Clinicians start with a detailed fundus examination, where the reddish-orange mass can be directly observed at the posterior pole of your eye.

Imaging Modalities & Underlying Causes and Risk Factors & Treatment Options and Procedures & Available Treatments & Treatment Process

  • Ultrasound B-scan: This technique provides a cross-sectional view of the eye, confirming the dome-shaped nature and high internal reflectivity of the lesion.
  • Fluorescein Angiography (FA): FA helps in assessing the blood flow within the abnormal vessels. It typically shows early hyperfluorescence followed by late staining, which helps delineate the borders of the hemangioma.
  • Indocyanine Green Angiography (ICG): ICG is used for its wash-in and wash-out pattern that gives more precise information about the vascular network within the lesion.
  • Optical Coherence Tomography (OCT): OCT is invaluable for its ability to detect subretinal fluid, assess changes in the retinal pigment epithelium, and even reveal cystoid macular edema—a condition where fluid-filled cysts develop in the macula, further impairing vision.
  • MRI: Magnetic Resonance Imaging is especially useful when a diffuse hemangioma is suspected, as it highlights a thickened choroid with a distinctive high-intensity signal on both T1 and T2 images.

Each of these imaging techniques contributes to a comprehensive evaluation that ensures our retina specialists can craft a tailored treatment plan for each individual case.

At its core, choroidal hemangioma arises from an abnormal proliferation of blood vessels in the choroid that are embedded in a fibrous stroma. The exact cause is not fully understood, but several key factors are at play:

  • Vascular abnormalities: The core of the pathology involves vascular channels lined by endothelial cells. These abnormal vessels tend to leak fluid, which is primarily responsible for vision complications.
  • Structural susceptibility: The choroid is a highly vascularized layer of the eye, making it susceptible to changes that disrupt the normal balance of fluid and blood flow.
  • Systemic associations: In cases of diffuse choroidal hemangioma, the linkage with Sturge-Weber syndrome is significant. This syndrome is characterized by facial port-wine stains, leptomeningeal angiomas (affecting the brain’s coverings), and ocular involvement, making early systemic evaluation crucial.

The precise triggers for these vascular changes remain a subject of ongoing research, but understanding these factors is essential for managing the condition effectively.

Treatment for choroidal hemangioma is generally reserved for patients who develop symptoms or show signs of vision-compromising fluid accumulation. The approach depends on the type of hemangioma and the extent of retinal involvement. Our retina specialists recommend treatment when there is significant macular involvement or when fluid leakage begins to affect vision.

  • Photodynamic Therapy (PDT): This is the first-line treatment for circumscribed choroidal hemangioma. PDT is highly effective and minimally invasive. It works by targeting the abnormal blood vessels with a light-activated drug that seals them off, reducing fluid leakage and minimizing further damage.
  • External Beam Radiation Therapy (EBRT): Often used for diffuse hemangiomas or larger circumscribed lesions when PDT might not be feasible. EBRT involves directing targeted radiation to reduce the size of the tumor and control fluid leakage.
  • Transpupillary Thermotherapy (TTT): This option is typically considered for small to medium-sized tumors. TTT uses heat to shrink the tumor, proving to be a viable alternative if PDT is not optimal.
  • Plaque Brachytherapy: For cases where the tumor is large or refractory to other treatments, this method involves placing a small, radioactive implant near the lesion to deliver a controlled dose of radiation directly to the affected area.
  • Anti-VEGF Injections: While not curative on their own, these injections can serve as adjunctive therapy. They help reduce macular edema by targeting the vascular endothelial growth factor (VEGF) that promotes abnormal blood vessel formation and leakage.

The treatment journey for choroidal hemangioma often begins with a comprehensive evaluation that includes imaging and clinical examination. Once a clear diagnosis is established, our retina specialists will discuss the best treatment option with you. Here’s what to expect:

  • Pre-treatment Evaluation: Detailed imaging with OCT, FA, or even an MRI may be conducted to assess the impact of the tumor on the retina and surrounding tissues.
  • Treatment Session: Depending on the chosen therapy (for instance, PDT or EBRT), the procedure is usually straightforward and minimally invasive. Many procedures are done on an outpatient basis, allowing you to return home the same day.
  • Post-treatment Monitoring: Regular follow-up appointments are an essential part of the treatment process. These visits help our retina specialists monitor the tumor's response, check for any recurrence, and manage any remaining fluid promptly.

By carefully monitoring the condition, our retina specialists work to ensure that any changes are spotted early, giving you the best chance at maintaining your vision.

If you're experiencing vision changes or need specialized care for choroidal hemangioma, contact our retina specialists today. Our dedicated team is committed to providing you with the best treatment options tailored to your needs. Schedule a consultation and take the first step toward preserving your vision.

Role of Imaging in Monitoring Progression & Imaging Techniques & Associated Conditions & Link with Sturge-Weber Syndrome & Prognosis Factors

  • Ultrasound B-scan: Offers a detailed cross-sectional image of the tumor, revealing its shape and internal reflectivity.
  • Fluorescein Angiography (FA) and Indocyanine Green Angiography (ICG): These imaging modalities help track the flow of blood within the tumor, observe leakage patterns, and guide treatment decisions. FA, specifically, is useful in highlighting areas of hyperfluorescence and identifying leakage zones, while ICG provides a clear delineation of the lesion’s borders.
  • Optical Coherence Tomography (OCT): An indispensable tool, OCT provides cross-sectional images of the retina. By visualizing the extent of subretinal fluid, RPE changes, and even signs of cystoid macular edema, OCT plays a primary role in both the diagnosis and follow-up of the disease.
  • MRI: Particularly useful for assessing diffuse choroidal hemangiomas, MRI helps to evaluate the overall thickness of the choroid and to detect any associated high-intensity signals that correspond to the lesion.

These imaging techniques allow our retina specialists to continuously evaluate the response to therapy and make adjustments as needed, ensuring that any complications are addressed quickly before they affect your vision permanently.

In cases of diffuse choroidal hemangioma, there is often an association with Sturge-Weber syndrome. This syndrome is a neurocutaneous disorder that not only affects the eye but also the skin and brain. Patients with Sturge-Weber syndrome may present with:

  • Port-wine stains: A visible discoloration usually appearing on the face, often in the V1 dermatome region surrounding the eye.
  • Neurological symptoms: Seizures or other neurological issues can sometimes be observed due to abnormal blood vessel development in the brain.
  • Glaucoma: Increased intraocular pressure, which may further compromise vision if not well managed.

The presence of these additional signs mandates a multidisciplinary approach to care. Besides ocular evaluations, patients may need to see other specialists to manage neurological or dermatological aspects of the syndrome. This coordinated care is essential to not only treat the choroidal hemangioma but also to safeguard overall health.

The prognosis for patients with choroidal hemangioma largely depends on the timeliness of diagnosis and how quickly treatment is initiated. With circumscribed choroidal hemangioma, favorable outcomes are commonly seen when photodynamic therapy is deployed before the macula sustains damage. However, diffuse choroidal hemangiomas present a more challenging scenario, mainly because of their association with systemic features such as Sturge-Weber syndrome.

Other factors that can influence prognosis include:

  • Extent of retinal involvement: The amount of subretinal fluid and the degree of RPE alteration can impact visual outcomes.
  • Speed of treatment: Early and accurate treatment can prevent recurrence and further damage, preserving visual function.
  • Regular follow-up: Continuous monitoring ensures that any recurrence or complications are managed rapidly.

When you partner with our retina specialists, you'll receive a tailored treatment plan that takes all these factors into account to help maintain the best possible visual health.

Patient Recommendations & Recommended Actions & Final Thoughts and Next Steps & Summary

Facing a diagnosis related to choroidal hemangioma can be overwhelming, but rest assured that our team is here to help. We encourage anyone experiencing gradual vision loss, unusual visual changes, or signs that might indicate a retinal detachment to schedule an evaluation as soon as possible. Early intervention not only preserves vision but also enhances overall treatment success.

  • Schedule regular eye examinations: Consistent monitoring is essential, particularly for those at higher risk or with existing retinal abnormalities.
  • Follow up on any changes in vision: Inform our retina specialists immediately if you notice any new changes such as blurred vision, distortion, or the sudden appearance of floaters.
  • Discuss all treatment options: Treatment plans, including considerations for photodynamic therapy, external beam radiation therapy, or other alternatives, should be discussed in detail. Your care plan will be fully customized to address the unique characteristics of your condition.
  • Engage in multidisciplinary care if needed: For those with diffuse choroidal hemangioma, especially when connected with Sturge-Weber syndrome, working with a team of specialists ensures all aspects of your health are managed effectively.

Your visual health is our top priority, and we remain committed to providing the personalized attention and informed care that you deserve.

Choroidal hemangioma, though benign, can threaten vision if left untreated. With advanced imaging, personalized treatments, and ongoing monitoring by our retina specialists, you can maintain excellent visual outcomes. For any concerns or changes in your vision, please contact our office for a consultation.

Choroidal Hemangioma: Understanding This Benign Eye Tumor

If you're experiencing vision changes or need specialized care for choroidal hemangioma, contact our retina specialists today. Our dedicated team is committed to providing you with the best treatment options tailored to your needs. Schedule a consultation and take the first step toward preserving your vision.

Common Questions

Choroidal hemangiomas are benign tumors formed by abnormal blood vessels in the choroid layer of the eye. They can cause vision complications but are non-cancerous.
The two main types are Circumscribed Choroidal Hemangioma (CCH), which is typically solitary, and Diffuse Choroidal Hemangioma (DCH), often associated with Sturge-Weber syndrome.
Common symptoms include gradual vision loss, visual distortion, or sudden changes in eyesight, particularly if there is fluid leakage affecting the retina.
Diagnosis typically involves a comprehensive eye exam and imaging techniques such as ultrasound B-scan, fluorescein angiography, or optical coherence tomography.
Treatment may involve photodynamic therapy, external beam radiation, or other techniques depending on the type and severity of the hemangioma.
Regular follow-ups and monitoring are crucial for managing choroidal hemangiomas, especially to detect any changes in vision or tumor progression.
Amplify EyeCare cartoon

Choroidal Hemangioma: Understanding This Benign Eye Tumor

Choroidal hemangioma is a benign eye tumor. Learn about its types, symptoms, and treatment options from our expert retina specialists.

Logo Specialty Vision Stacked Fullcolor1

Find a Doctor

Grow Your Practice
starchevron-downarrow-up