Synonyms in a broader sense

Vascular skin (uvea)

Medical: Choroid

English: choroid

introduction

The choroid (Choroid) is the rear part of the vascular skin (Uvea) of the eye. It is embedded between the retina and the dermis as a middle shell. The vascular skin also includes the iris and the ciliary body (Corpus ciliary). With its network of blood vessels, it serves to nourish neighboring structures in the eye and itself consists of three layers. Since the choroid does not carry any sensitive nerve fibers, pain always indicates an involvement of neighboring structures with sensitive nerve fibers.

The blood flow through the choroid is the strongest in the entire human body.

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Structure of the choroid

The choroid belongs to the vascular skin, also called the middle eye skin (Uvea). In addition to the choroid, it includes the rainbow skin and the ciliary body. It lies between the retina (retina) and the dermis (Sclera).

The choroid consists of the following four layers from the inside out:

  • Lamina basalis (Link with retina)
  • Lamina choroidocapillaris (small capillaries)
  • Lamina vasculosa (large arteries)
  • Lamina suprachoroidea (Link with dermis)

Function of the choroid

The choroid (Choroid) has several functions: It contains many blood vessels and thus ensures the supply of parts of the eyeball (Bulbus oculi) with oxygen and nutrients that cells need to survive. In particular, the outer layer of the retina (retina) is supplied by the blood vessels of the choroid. The retina, like the brain, has a barrier so that only selected substances can get into it: the Blood-retinal barrier (analogous: Blood-brain barrier). Therefore, the pigment epithelium, which anatomically belongs to the retina, lies between the choroid and the retina. The cells of the pigment epithelium are firmly connected to each other and ensure that only required substances from the blood, which flows in the vessels of the choroid, can penetrate the retina. The rich blood flow to the choroid is also the cause of the undesirable "red eyes" -Effect "when taking photos. If overexposed, it shimmers through the eye in red.

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Another function of the choroid is the ability of the eye to accommodate, i.e. the ability of the eye to see objects near or far away clearly. The part of the choroid that is responsible for this function is called Bruch's membrane. The Bruch's membrane contains many elastic fibers and is the antagonist of the ciliary muscle, which contracts the lens for near vision and thus makes it more spherical. Distance accommodation, on the other hand, is ensured by the passive restoring force of the elastic fibers of the Bruch's membrane and thus by the choroid.

Last but not least, the choroid is also heavily pigmented and, together with the pigment epithelium mentioned above, ensures that as little as possible of the light falling into the eye is reflected. Instead, the light is completely absorbed, which is very important for seeing in different lighting conditions. In addition, the strong pigmentation of the choroid prevents the uncontrolled reflection of light inside the vitreous body from causing confusing stimuli on the retina.

Choroid anatomy

The choroid (Choroid) is one of the three parts of the vascular skin (Uvea) of the eye. It lies against the retina from the outside. First, the Bruch membrane attaches itself to the cells of the retina from the outside, which receive the light impulses (Photoreceptors). The Bruch's membrane consists of connective tissue and is because of its structural proteins (Collagen fibers) and the reversibly stretchable elastic fibers too Lamina elastica called.

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This is followed by a layer with network-like branching small blood vessels (capillaries). The cells of the blood vessels are spaced far apart (fenestrated capillaries) so that certain blood components can easily escape from the vessels. They are used for nutrition. These windows are sealed by the cells that receive the light impulses (pigment epithelium or photoreceptors) and the Bruch's membrane.

The last layer consists of larger vessels and is the layer with the plexus-like branched small blood vessels (Choriocapillaris) from the outside. This outermost layer of the choroid carries larger blood vessels. These are mostly veins that carry blood away from the eye. The choroid is pulled outwards by the dermis (Sclera) limited.

Illustration: Horizontal section through the left eyeball, seen from below
  1. Cornea - Cornea
  2. Dermis - Sclera
  3. Iris - iris
  4. Radiation body - Corpus ciliary
  5. Choroid - Choroid
  6. Retina - retina
  7. Anterior chamber of the eye -
    Camera anterior
  8. Chamber angle -
    Angulus irodocomealis
  9. Posterior chamber of the eye -
    Camera posterior
  10. Eye lens - Lens
  11. Vitreous - Corpus vitreum
  12. Yellow spot - Macula lutea
  13. Blind spot -
    Discus nervi optici
  14. Optic nerve (2nd cranial nerve) -
    Optic nerve
  15. Main line of sight - Axis opticus
  16. Axis of the eyeball - Axis bulbi
  17. Lateral rectus eye muscle -
    Lateral rectus muscle
  18. Inner rectus eye muscle -
    Medial rectus muscle

You can find an overview of all Dr-Gumpert images at: medical illustrations

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physiology

The choroid contains a large number of blood vessels. These have a total of two tasks. The first important job is to nourish the outer layer of the retina. These are mainly the photoreceptors, which receive and transmit the light impulses. The retina in turn consists of several layers. The more inner layers are filled with blood through a specific blood vessel, namely from the branches of the Central retinal artery, provided.

It has been observed that the choroid has a very high blood flow due to the strong plexus formation through blood vessels, but that the oxygen exhaustion from the red blood cells is relatively low. This is the reference to the second important function of the choroid, namely temperature regulation. In the process of processing and forwarding the on the sensory cells (Photoreceptors) incoming light stimuli generate heat that is dissipated by the blood vessels. This adjusts the temperature in the eye and keeps it stable.

Choroid Diseases

Since the choroid does not contain any pain fibers, pain only occurs when diseases of the choroid spread to neighboring areas supplied with pain fibers or when there is an increase in pressure.However, visual disturbances may occur, the severity of which depends on where the disease is located on the fundus of the eye. Tumors often go undetected for a long time.

Choroidal inflammation

An inflammation of the choroid (chorioditis) usually occurs as a result of an allergic reaction (immunological disease). However, it can also be triggered by foreign bodies that get into the eye from outside or by germs from other sources of inflammation in the face and skull. The reason for this is the good blood circulation in the choroid, which not only supplies it with nutrients, but can also spread pathogens and germs into the choroid if there is an infection. Possible pathogens can be bacteria, viruses or fungi. Immune-weakened people are considered to be risk groups, as the body's own immune system cannot kill the germs sufficiently.

Since the choroid itself does not contain any nerve fibers, pain only manifests itself when adjacent structures such as the dermis or retina are affected. Tension pain occurs, usually as a result of increased intraocular pressure. In addition, as a result of the inflammation of the neighboring retina, those affected suffer from visual disturbances, cloudiness and haze formation as well as a general decrease in visual performance. In most cases, a noticeably reddened eye can be seen from the outside.

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The ophthalmologist will first perform an eye test to see whether there are already visual field losses. The eye is then examined using a slit lamp in order to be able to assess the anterior and inner parts of the eye. In order to be able to see the fundus, consisting of the retina and the underlying eyes, the pupil must be spread wide. A tonoscopy is performed to determine if pressure inside the eye may have increased.

At a Chorioditis action should be taken quickly because otherwise it can lead to permanent visual disturbances or, in the worst case, to blindness. Immediate therapy consists of tablets containing cortisone to combat the focus of inflammation. In addition, pressure-lowering medication is given to protect the surrounding structures, such as the optic nerve head, from the increased pressure.

An inflammation of the choroid can develop individually both in the course of the disease and in the degree of severity. The exact therapy should therefore be determined by an ophthalmologist.

Read more here: Choroidal inflammation

Choroidal coloboma

A Coloboma (Greek "the mutilated") is a congenital or acquired gap in the eye. In the congenital variant, in the embryonic development of the eye there is insufficient or incorrect closure of the eye cup cleft during the 4th to 15th week of pregnancy. The causes of these embryological malformations are still the subject of current research. Mutations in the so-called PAX genes, which take on many regulatory functions in embryonic development, are discussed.

Acquired choroidal colobomas usually result from external violence (e.g. blow to the eye, accident, etc.) or complications during operations on the eye.

Read more on the subject at: Coloboma on the eye

Choroidal hemangioma

The choroidal hemangioma is a vascular tumor (hemangioma) located in the choroid of the eye. Due to the numerous branches into many small vessels and capillaries, the tumor is also very branched and cavernous, as it follows the course of the vessels. People between the ages of 10 and 40 are particularly affected. The choroidal hemangioma is usually benign and presents no symptoms. Only when the surrounding tissue of the capillaries is affected (exudative stage) do visual disturbances such as clouded or distorted vision occur. An ultrasound or fluorescent angiography is performed to establish the diagnosis to show the extent and size of the tumor. Treatment is only necessary if there is a visual threat in the exudative stage.

Choroidal atrophy

The choroidal atrophy refers to tissue atrophy caused by the death of the choroid cells. This is usually the result of a degenerate tissue such as a tumor. Depending on the location, size and extent of the atrophy, this can have significant consequences for the eye.

In the initial stage, there are visual disturbances and an increased susceptibility to infections, since, among other things, the blood-retina barrier can be disrupted and germs can pass into the retina unhindered. If the choroidal atrophy is severe, complete blindness can occur.

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Choroidal folds

Choroidal folds usually arise as a result of a mass in the eye socket, such as a tumor, calcifications or a congested pupil. This exerts increased external pressure on the eyeball. This gives way to the pressure and the individual layers of the eye, consisting of the retina, choroid and dermis, fold up. If only the choroid is affected, this does not result in any visual disturbances. However, there is a risk that small blood vessels will be pinched off by the folds and this will lead to an insufficient supply of oxygen and nutrients. However, if the retina is also affected, the retinal folds cause visual field losses, which in the case of one-sided disease can, however, still be compensated by the healthy eye.

Choroidal melanoma

The choroidal melanoma (Malignant uveal melanoma) is a malignant tumor that results from the pigmented cells of the choroid, the so-called Melanocytes, can develop when they begin to divide uncontrollably. It is the most common tumor of the eye, one in 100,000 in Europe suffers from it. The maximum age for the disease is between sixty and seventy years of age. Since the degenerated melanocytes are full of the pigment melanin, most choroidal melanomas are darkly pigmented.

Like most malignant tumors, choroidal melanoma tends to spread (about 50% of cases). It is mostly spread through the bloodstream into the liver. If there is already a spread, the disease usually leads to death within a few months / years. Since the choroid, unlike most other parts of the body, does not contain lymph vessels, which are of great importance for the immune system, the degenerated cells often remain undetected by the body and are therefore not fought by the immune system. A sick person's complaints mainly include blurred vision and double vision. Choroidal melanomas are often discovered incidentally by the ophthalmologist.

Treatment options range from radiation and laser therapy to radiosurgery and removal of the affected eye.

The choroidal melanoma must be differentiated from choroidal metastases. These are rather flat, gray-brown tumors that were mostly spread from breast cancer or lung cancer. There is also the benign choroidal nevus as a differential diagnosis.

You can also read a lot more information at: Choroidal melanoma

Choroidal nevus

In contrast to a choroidal melanoma, a choroidal nevus is a benign, i.e. benign, tumor. It is usually more strongly pigmented, sharply defined and does not grow progressively. Choroidal nevi appear dark due to a build-up of melanin (similar to a birthmark on the skin). It lies below the retina and does not cause any visual disturbances. Approx. 11% of the population are carriers of such a nevus, making it the most common tumor of the inside of the eye. Mostly it is innate. Because there are no symptoms, it is often noticed by chance during an eye background examination.

Rarely, in about 5 out of 10,000 cases, such a nevus can develop into a choroidal melanoma. Certain factors such as the size, location, pigmentation or accumulation of fluid in the tumor indicate an increased risk of degeneration. A choroidal nevus should therefore be checked regularly to see if it shows a tendency to grow. A check-up should be arranged every six months. If the findings are unclear, a tissue sample (biopsy) can provide clarity. This is obtained with a small needle.

In addition to the fundus examination, fluorescein angiography, indocyanine green angiography, fundus autofluorescence and optical coherence tomography are available for examining a nevus.

Read more about this under: Birthmark in the eye

Examination of the choroid

Choroid

If the doctor looks through the pupil with special devices during the eye examination (Ophthalmoscopy), the choroid can only be assessed directly with difficulty because the retina limits the view of the choroid for anatomical reasons. The so-called ophthalmoscopic image is important for the diagnosis and course of diseases. Ultrasound examinations can also detect pathological changes in the choroid. Fluorescence angiography describes a special way of displaying blood vessels. It is an imaging procedure in which the blood flow to the fundus of the eye (see also: Fundoscopy) is observed and assessed through a medically dilated pupil by administering a suitable dye. If a tumor of the choroid is suspected, a cold light source placed on the eye can cause shadowing in the area of ​​the tumor.


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