Choroid

Blood supply

The human eye is supplied by two largely distinct vascular systems: the retinal circulation, which nourishes the inner retina, and the uveal circulation (choroidal, ciliary body and iris), which nourishes the uvea and the outer retina (via the choroid). Both systems arise primarily from the ophthalmic artery, a branch of the internal carotid artery.

The uveal circulation is supplied mainly by the posterior ciliary arteries (short and long), which enter the globe independently of the optic nerve. These arteries provide the dominant blood supply to the choroid and contribute importantly to perfusion of the optic nerve head (including the anterior portion of the optic nerve). The retinal circulation derives primarily from the central retinal artery, which travels within the optic nerve and enters the eye at the optic disc. It then branches over the inner retinal surface into arterioles and capillaries supplying the nerve fiber and inner retinal layers.

Retinal arteries behave as functional end-arteries with limited collateralization; consequently, focal obstruction can produce sectoral retinal ischemia. By contrast, the choroid exhibits a segmental vascular organization, and regional perfusion territories supplied by posterior ciliary arteries are clinically relevant because the macula and the anterior optic nerve (structures critical for central vision) depend strongly on choroidal perfusion.

Imaging the choroid and its blood flow

Structural features of the choroid can be assessed with optical coherence tomography (OCT), while choroidal vascular contrast is classically obtained with indocyanine green angiography (ICGA), an invasive dye-based method that is relatively robust for deeper choroidal vessels. Optical coherence tomography angiography (OCTA) provides non-invasive motion-contrast maps but can be limited by depth-dependent sensitivity, segmentation/projection artifacts, and reduced sensitivity for very slow flow or deeper large vessels.

Laser-Doppler–based approaches provide an additional, non-invasive route to choroidal flow contrast. In ophthalmology, Laser Doppler holography (LDH) is a full-field, camera-based implementation that uses digital holography and temporal demodulation of reconstructed optical fluctuations to generate Doppler power maps that highlight blood-flow–related signals in retinal and choroidal vessels.

Signal-processing refinements (e.g., spatio-temporal filtering and decomposition methods) have been reported to improve visualization of slower flow components and enhance choroidal vessel contrast in LDH datasets.

Wide-field extensions of Doppler holography have also been described in conference literature for imaging choroidal blood flow over larger posterior-pole regions, with the aim of visualizing major choroidal arteries/veins and outflow patterns (including drainage toward vortex veins) that may be relevant in conditions such as the pachychoroid disease spectrum.

In bony fish

Teleosts bear a body of capillaries adjacent to the optic nerve called the choroidal gland. Though its function is not known, it is believed to be a supplemental oxygen carrier.

Mechanism

Melanin, a dark colored pigment, helps the choroid limit uncontrolled reflection within the eye that would potentially result in the perception of confusing images.

In humans and most other primates, melanin occurs throughout the choroid. In albino humans, frequently melanin is absent and vision is low. In many animals, however, the partial absence of melanin contributes to superior night vision. In these animals, melanin is absent from a section of the choroid and within that section a layer of highly reflective tissue, the tapetum lucidum, helps to collect light by reflecting it in a controlled manner. The uncontrolled reflection of light from dark choroid produces the photographic red-eye effect on photos, whereas the controlled reflection of light from the tapetum lucidum produces eyeshine (see Tapetum lucidum).

History

The choroid was first described by Democritus (c. 460 – c. 370 BCE) around 400 BCE, calling it the "chitoon malista somphos" (more spongy tunic than the [sclera]). Democritus likely saw the choroid from dissections of animal eyes.

About 100 years later, Herophilos (c. 335 – 280 BCE) also described the choroid from his dissections on eyes of cadavers.

Clinical significance

Choroid is the most common site for metastasis in the eye due to its extensive vascular supply. The origin of the metastases are usually from breast cancer, lung cancer, gastrointestinal cancer, and kidney cancer. Bilateral choroidal metastases are usually due to breast cancer, while unilateral metastasis is due to lung cancer. Choroidal metastases should be differentiated from uveal melanoma, where the latter is a primary tumour arising from the choroid itself.

Additional images

Schematic diagram of the human eye en.svg|Schematic cross section of the human eye; choroid is shown in purple. File:Laser_Doppler_holography_of_retinal_and_choroidal_blood_flow.jpg|Laser Doppler imaging of retinal and choroidal blood flow File:Gray878.png|Iris, front view File:Gray880.png|The terminal portion of the optic nerve and its entrance into the eyeball, in horizontal section File:Gray1206.png|The interior of the posterior half of the left eyeball File:Three Main Layers of the Eye.png|Structures of the eye labeled File:Three Internal chambers of the Eye.svg|This image shows another labeled view of the structures of the eye File:Calf-Eye-Posterior-With-Retina-Detached-2005-Oct-13.jpg|Calf's eye dissected to expose the choroid: its tapetum lucidum is iridescent blue

References

References

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