Choroidal varix elevates macula following Valsalva manoeuvre

Choroidal blood drainage is highly varied.1 Generally, each of the four quadrants of the eye converge to form a large dilated vascular channel called the ampulla. The ampulla is about 1.5–2 mm wide and up to 5 mm long; it drains into the vortex veins.2 The main drainage route is through 6–8 vortex veins, which perforate the sclera at the equator. Another route is defined as the posterior route, where the blood drains out either through the choriovaginal veins, which penetrate the sclera near the optic nerve on the macular side, or through the macular vortex veins, which penetrate the sclera under the macula.3 (figure 1A) Figure 1 (A) A scheme to demonstrate the choroidal drainage. Green vessels show the peripheral drainage. Blue and red vessels show the rare peripheral drainage. Blue vessels demonstrate choriovaginal vessels, red vessels demonstrate the macular vortex veins. Black arrows show the direction of the flow and the drainage point. (B) Fundus photography of the left eye. (C) Indocyanine green angiography of the left eye while normal breathing. (D) Indocyanine green angiography while performing Valsalva manoeuvre. The difference is not noticeable. Unusual dilation of the peripherally routed vortex veins at the site of ampulla has been reported a number of times.4–8 Choroidal varices are generally asymptomatic and often found coincidentally in patients of middle age.4 The aetiology is unknown, but …