Choroidal detachments occur when there is an accumulation of fluid or blood in the suprachoroidal space, a potential space situated between the choroid and the sclera. They are an uncommon ocular pathology. The most common cause of choroidal detachment is secondary to trabeculectomy; however, there are other causes such as trauma and inflammation. Clinically, choroidal detachments may vary in presentation from asymptomatic, to very poor vision, severe ocular pain, vomiting and nausea. Ocular findings associated with choroidal detachments include serous retinal detachment, secondary angle closure, and a very shallow anterior chamber. Optometrists, as primary eye care providers, need to be aware of the clinical signs and symptoms associated with choroidal detachments and ensure that appropriate and timely management, with a referral to an ophthalmologist, is instigated for optimal visual outcomes. In this review, the pathophysiology, detection, and associated risk factors for choroidal detachments are discussed, and evidence-based management recommendations in an optometric context are provided. The characteristics and management of uveal effusion syndrome are also reviewed, as this can cause idiopathic exudative choroidal detachments distinct from classical choroidal detachment.

Purpose Aquaporin‐4 (AQP4) and potassium channel Kir4.1 are normally expressed in retinal Müller glia, and play a major role in controlling retinal fluid and maintaining retinal integrity and function. We examined AQP4 and Kir4.1 distribution and expression in human eyes with late age‐related macular degeneration (AMD) or long‐term serous retinal detachment secondary to choroidal melanoma. Methods Paraffin sections of central and peripheral choroid/retina from young (<40 years, n=5), aged (>70 years, n=4) and AMD (>70 years, n=5) human post‐mortem eyes, and whole human eyes with choroidal melanoma (n=5), were co‐immunolabelled with antibodies to AQP4, Kir4.1 and GFAP, and visualised using immunofluoresence and confocal microscopy. Results We found differential expression of AQP4 and Kir4.1 in detached retina of melanoma eyes, with upregulation of AQP4 and downregulation of Kir4.1 compared to unaffected eyes. This was most obvious in the retina overlying melanomas and in detached retina separated from underlying choroid. GFAP immunoreactitvity was upregulated in areas of serous retinal detachment, and retinal thinning; Müller cell processes extended along the anterior surface of melanomas. No apparent difference in distribution or expression of AQP4 or Kir4.1 was observed for retinas with late stage AMD compared to controls. Conclusion Decreased Kir4.1 expression in long term serous retinal detachment may be associated with Müller cell proliferative gliosis, as suggested in earlier animal studies. Increased AQP4 expression suggests efforts to restore retinal fluid balance in areas with photoreceptor degeneration and compromised outer blood‐retinal barrier. Support: NFMRI (MCM), Lions NSW Eye Eyebank