Serpiginous choroiditis (serpiginous choroidopathy): symptoms, diagnosis and care

The choroid is the layer of blood vessels that supplies and supports the retina, the light-sensitive layer at the back of the eye that enables you to see. UHB explains that in serpiginous choroidopathy inflammation occurs in these sensitive structures. UHB notes that on examination areas of active inflammation appear as grey-white areas spreading from the optic nerve.

Uveitis is the general term the NHS uses for inflammation inside the eye. UHB groups uveitis by the part of the eye affected: the front (anterior), middle (intermediate), back (posterior) or all parts (panuveitis). Serpiginous choroidopathy is a form of posterior uveitis. Unlike most other forms of uveitis, UHB says there is no inflammation in other parts of the eye and the condition tends to respond less well to immunosuppressant drugs, which is one reason it is looked after in specialist services.

According to UHB, the first thing that most patients notice is an area of blurred vision or partial blind spots caused by changes in the retina and the choroid. It is not painful. By contrast, the NHS lists eye pain among the common symptoms of uveitis more generally, so the absence of pain does not make a change in vision less important.

The NHS adds that uveitis in general can cause eye pain that may be worse when reading, red or watery eyes, reduced or blurred vision, sensitivity to light and floaters or flashes. Symptoms can develop in hours and days or gradually over weeks and months, and sometimes there are no symptoms at all. Because many conditions can cause similar symptoms, including glaucoma, other types of infection or inflammation and eye injury, a proper examination is needed.

• Ask for an urgent GP appointment or get help from NHS 111 if you have eye pain, sensitivity to light, changes in your vision such as flashing or blurring, or very red eyes.

• Go to A&E or call 999 if you cannot see (loss of vision).

UHB explains that examination of the retina and choroid by an ophthalmologist reveals areas of damage. These can be recorded by photography and by newer scanning instruments such as optical coherence tomography. A clinic visit typically includes measurement of vision, anaesthetic drops so the eye pressure can be measured, and dilating drops that allow the back of the eye to be seen in more detail.

Specialist imaging is described as a very important part of assessment. It helps to show whether the condition is still active or controlled and guides treatment. In active disease, areas of inflammation look grey-white and may spread from the optic nerve. Over time these may form scars with thinning of the overlying retina. The NHS notes that causes of uveitis in general include autoimmune conditions and some infections, so the cause is considered as part of the assessment.

UHB says over time areas of active inflammation may form scars with thinning of the overlying retina. It also says serpiginous areas sometimes lead to a choroidal neovascular membrane (CNV), where abnormal blood vessels grow from the damaged choroid through to the retina. This can cause distortion of what you see and further loss of vision, so new distortion or worsening of your vision is something to report promptly to the eye team.

The NHS says that in uveitis generally it is important to get treated early to avoid long-term complications such as vision loss and blindness. It also says that uveitis can come back over time, so ongoing review matters even when things have settled.

UHB describes the condition as one that needs specialist treatment to prevent irreversible damage and says it tends to respond less well to immunosuppressant drugs than other forms of uveitis. For uveitis generally the NHS lists medicines to reduce inflammation and relax the eye, and, if it is very severe or keeps coming back, medicines that reduce the activity of the immune system (immunosuppressants) and TNF inhibitors, light treatment, cryotherapy or surgery on part of the eye. The choice for any individual depends on the cause and severity, which the treating ophthalmologist will explain.

Follow-up is regular. UHB says that local patients attending its specialist clinic are likely to have around four appointments a year, while people living further away share care between the specialist clinic and their local eye specialist, perhaps with two review appointments a year at the specialist service. The NHS says that after treatment starts you will be seen again to check how well it is working, to look for side effects and to check for complications such as vision loss.

UHB notes that researchers, including scientists, patients and doctors, are continuing to study what triggers serpiginous choroidopathy and how to treat it better. For a rare condition it can help to be seen in a service that sees several people with it, and to keep a record of your scans and treatment so that care can be shared between hospitals.

On the NHS, a GP who suspects uveitis refers to an eye specialist, and the NHS says you will usually be seen within 24 hours so that treatment can start quickly. Rare posterior uveitis is then often looked after by a specialist uveitis or rare-disease service. Private ophthalmology can offer quicker access to imaging and review, but the specialist imaging, drug monitoring and complication management are the same, and many people combine both. Ask for copies of your scans so they can follow you between services.