Etiology:
The underlying etiology and pathophysiology of FCE remains elusive. Some authors subscribe to a congenital/developmental hypothesis2 given its apparent predilection for moderate to highly myopic eyes. Other evidence suggests FCE is an acquired condition secondary to retinal or choroidal insult (see below). Overall, it appears to be most closely associated with myopia2, however, it has also been described in hyperopic and emmetropic eyes.
Recent literature has implicated FCE as a pachychoroid spectrum disease5 related to central serous chorioretinopathy (CSCR) as it has been observed in patients with both abnormally thick choroids and either active CSCR or a history of such. This apparent association is contradictory, however, as CSCR is generally observed in hyperopic eyes6 and, as mentioned, FCE is thought to be related to myopic eyes.
Interestingly, FCE has also been implicated in cases of acquired maculopathies such as multiple evanescent white dot syndrome (MEWDS)7 and age-related macular degeneration (AMD)8.