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What Is Multifocal Choroiditis?

Multifocal choroiditis is an inflammatory disorder characterized by multiple small lesions in the choroid and retina, often in young to middle aged myopic women. Lesions can be active, with yellow white appearance and overlying vitritis, or healed, with punched out chorioretinal scars. The macula is frequently involved, and choroidal neovascularization (CNV) is a common complication. Symptoms include blurred vision, scotomas, and floaters. The condition can be bilateral and recurrent.

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What Is Multifocal Choroiditis?

Multifocal choroiditis is an inflammatory disorder characterized by multiple small lesions in the choroid and retina, often in young to middle aged myopic women. Lesions can be active, with yellow white appearance and overlying vitritis, or healed, with punched out chorioretinal scars. The macula is frequently involved, and choroidal neovascularization (CNV) is a common complication. Symptoms include blurred vision, scotomas, and floaters. The condition can be bilateral and recurrent.

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Pathology and Possible Triggers

The exact cause of multifocal choroiditis is uncertain, but immune mediated mechanisms are strongly suspected. Inflammation targets the choriocapillaris, retinal pigment epithelium, and outer retina, leading to focal areas of necrosis and scarring. Many patients have no clear infectious trigger, although some cases resemble post infectious or post viral patterns. The disease sits within a spectrum that includes conditions such as punctate inner choroidopathy and other white dot syndromes. Recurrences can occur over many years.

Clinical Features and Imaging Findings

Patients often present with blurred central vision, paracentral scotomas, and photopsias, sometimes accompanied by floaters from vitritis. On fundus exam, active lesions appear as creamy, yellow white spots at the level of the RPE and inner choroid, while older lesions look like punched out scars with pigment clumping. Optical coherence tomography shows outer retinal disruption, RPE irregularities, and, when CNV is present, subretinal fluid or hyperreflective material. Fluorescein and indocyanine green angiography highlight active inflammation and neovascular membranes.

How Is Multifocal Choroiditis Diagnosed?

Diagnosis relies on clinical presentation combined with multimodal imaging and exclusion of infectious or systemic inflammatory causes. The eye care professional orders fluorescein angiography, OCT, and sometimes OCT angiography to map lesions and detect CNV. Systemic workup may include tests for syphilis, tuberculosis, sarcoidosis, and other inflammatory diseases. The overall pattern of recurrent multifocal lesions, vitritis, and characteristic scars helps differentiate multifocal choroiditis from similar entities.

How Is Multifocal Choroiditis Managed?

Treatment aims to control inflammation and address CNV promptly. Corticosteroids, either systemic or periocular, are often used for acute inflammatory episodes. Steroid sparing immunosuppressive agents are considered for recurrent or chronic disease to limit steroid exposure. CNV is usually treated with intravitreal anti VEGF injections, which can stabilize or improve vision. Long term follow up is needed to monitor for new inflammatory foci, recurrent CNV, and treatment side effects.

FAQs About Multifocal Choroiditis

Is multifocal choroiditis an infection?

Most cases appear immune mediated rather than directly infectious, though infections are ruled out before immunosuppression is started.

Does multifocal choroiditis always cause choroidal neovascularization?

Not always, but CNV is common and a major cause of visual loss in this condition. Regular imaging helps catch it early.

Can multifocal choroiditis go away on its own?

Individual lesions can heal and scar, but the tendency to form new lesions can persist. Ongoing monitoring and treatment help reduce long term damage.

Are both eyes usually affected in multifocal choroiditis?

Yes, both eyes are often involved, sometimes at different stages. Each eye is examined and imaged regularly during follow up.

References

MedGen. “Multifocal choroiditis.” https://www.ncbi.nlm.nih.gov/medgen/ (concept page)?838066354648479†L120-L128?

EyeWiki. “Idiopathic Multifocal Choroiditis.” https://eyewiki.org/Idiopathic_multifocal_choroiditis?458966188453917†L105-L144?

EyeRounds (University of Iowa). “Multifocal choroiditis and panuveitis (MCP).” https://eyerounds.org/atlas/pages/MCP/index.htm?865688511546958†L61-L68?

MalaCards. “Multifocal choroiditis.” https://www.malacards.org/card/multifocal_choroiditis?144289315959388†L109-L138?

PubMed Central. “Idiopathic multifocal choroiditis – therapy and management review.” https://pmc.ncbi.nlm.nih.gov/articles/PMC8743334/?781372597829979†L173-L178?

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