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Case of the month: July 2021

Updated: Sep 13, 2021

Elizabeth Marlow, MD details her patient's symptoms and treatment for CSR.

Central Serous Retinopathy

This is a 50-year-old woman who was referred by her optometrist for complaints of fluctuating central distortion of vision for the past 3 years, primarily affecting her right eye. On exam, VA was 20/100 pinhole 20/30 in the right eye, 20/80 pinhole 20/25 in the left eye. Below are her fundus photographs and OCT at her initial presentation. What’s her diagnosis?

Central serous chorioretinopathy (CSCR) is when fluid builds up under the retina. This creates visual distortion that makes lines appear crooked (metamorphopsia), objects appear smaller in the eye with fluid (aniseikonia), and colors are dim.

When fluid is seen under the retina, a fluorescein angiogram (FA) can help determine the source. This FA shows leakage of dye into the subretinal space in a pattern called the “smoke stack”, which is classic for CSCR.

Based on these imaging findings, we discussed treatment options of observation, intravitreal injections, oral medication, or laser. Given the long-standing nature of her symptoms, she elected to proceed with a laser treatment known as photodynamic therapy (PDT).

Three months after PDT, her subretinal fluid is resolved, and she feels her visual symptoms have improved. Her vision improved to 20/70 pinhole 20/40.

If you notice decreased vision or distortion, seek eye care immediately. If your general eye care provider sees fluid under the retina, we at Bay Area Retina Associates can help to determine the cause.

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