A young male presents with central scotoma in left eye. His right vision showed 6/6 vision. On examination, in the left eye, there was focal foveal detachment. What would be the next step?
Ans. b. Inquire about the use of steroids (Ref: Khurana 5/e pe p290)A young male presents with central scotoma in left eye. His right vision showed 6/6 vision. On examination, in she left eye, there was focal foveal detachment The clinical picture points towards a diagnosis of central serous retinopathy (CSR). which is associated with intake of systemic steroids. So. the next step is to inquire about the use of steroids."There is extensive evidence to the effect that corticosteroids (e.g. cortisone), commonly used to treat inflammations, allergies, skin conditions and even certain eye conditions, can trigger central serous retinopathy, aggravate it and cause relapses."- Khurana 3rd/e p263Central Serous Retinopathy (CSR)Characterized by spontaneous detachment of the neurosensory retina in the macular region, with or without retinal pigment epithelium detachmentQ.When the disorder is active it is characterized by leakage of fluid under the retinaQ that has a propensity to accumulate under the central macula.Etiology:Stress appears to play an important roleAssociated with cortisol and corticosteroidsQ."There is extensive evidence to the effect that corticosteroids (e.g. cortisone), commonly used to treat inflammations, allergies, skin conditions and even certain eye conditions, can trigger central serous retinopathy, aggravate it and cause relapses. "Clinical features:Typically affects malesQ between 20 and 40 years of age.Patients present with a sudden onset of painless Loss of vision (usually unilateral, in the involved eye).It is also associated with scotoma, micropsia and metamorphopsiaQ.The other eye is usually normal.Diagnosis:Fundus-fluorescein angiography helps in confirming the diagnosis. Two patterns are seen:Ink-blot patternQ: It consists of a small hyperfluorescent spot which gradually increases in size.Smoke-stack patternQ: It consists of a small hyperflourescent spot which ascends vertically like a smoke stack and gradually spreads laterally to take a mushroom or umbrella configuration.Treatment:Spontaneous resorption of subretinal fluid within 3-4 months, recovery of visual acuity usually followsQ.Any ongoing corticosteroid treatment should be tapered and stopped, where possibleQ.Laser photocoagulation: In cases where there is Little improvement in a 3-4 months duration, and the leakage is confined to a single or a few sources of leakage at a safe distance from the foveaQ.Photodynamic therapy (PDT) with verteporfin has shown promise as an effective treatment with minimal complications.Prognosis:ExcellentComplications: Subretinal neovascularization and pigment epifheliopathy.
Examine retrolental cells
Inquire about the use of steroids
Ask for history of trauma in the other eye
Examination under slit-lamp
Retinal Detachment