The human Eye (frontal view and a cut section) courtesy-internet

 

The eyes are windows to our brain. The human eye can be compared to a camera. As in a camera our eyes also have different parts. Different parts of the eye functions as one unit to make vision possible. The brain plays a very important role in our visual system.
When we look at an object, an inverted image is formed on the retina (a thin transparent membrane inside the eye) and this image is in turn sent to the brain (occipital cortex) via the optic nerve. This image is processed and interpreted by our brain and we are able to see. Our visual system is a complex system which requires close co-ordination between the eyes, brain and head. When a disease affects any of these parts vision may become defective.
CENTRAL SEROUS CHOROIDOPATHY
Also known as Central Serous Chorio-retinopathy(CSCR) is an disease affecting largely the young individuals, aged between 20-50 years. Usually males are more prone to develop CSCR than females. Typically a young individual suddenly experience dimness of vision in any time of the day or night

There is leaking of fluid from choroidal tissues behind the retina. The fluid mostly collects in the central macular area, resulting detachment of the macula from the tissue behind it (Retinal pigment epithelium).


Symptoms- observing a black circle in the central visual field, minification of objects (appear smaller than normal) with the affected eye and distortion of vision when looking at straight lines.


Cause- although several causes are put forward, it is largely thought to be idiopathic.
Stress- young persons with aggressive "type A" personalities, both physical and emotional stress or trauma.
Steroid- use of steroid(as a drug) for any other disease. Prescribed for inflammation, skin conditions, allergies, any other eye problems can trigger, worsen, and cause relapses.
Smoking .

Helicobacter pylori- is a bacteria, which naturally occur in the stomach also plays a role.
Systemic hypertension and obstructive sleep apnea may be associated with CSCR.


Investigations- most of the time CSCR can be diagnosed by clinical examination only. However, some investigations may be done in order to document and explanation, to find the leak if laser in planned or to find out associated choroidal neovascular membrane, retinal pigmentary atrophy etc. Fundus Fluorescein Angiography, Optical Coherence Tomography Angio OCT can be done.

 

 
Treatment- most cases (80-90%) recover spontaneously without treatment in 1- 2 months returning to 20/25 or better vision. However, many patients may continue to notice dyschromatopsia (defective color vision), loss of contrast sensitivity and metamorphopsia(distorted vision). There is a possibility of recurrence in the same eye in 40-50% cases. Rarely, permanent scars affecting central vision may develop.
Severe leakage, severe visual loss or CSCR of longer duration may be treated by focal laser to seal the leak. Laser photocoagulation has shown improved outcomes, especially in patients with recurring episodes. A very small number of people may have complications from laser treatment impairing central vision. In another small percentage of patients ( mostly elderly patients) choroidal neovascularization may develop.

Patients who are using steroid should discontinue their use(if possible) after consulting their physician.
Recently photodynamic therapy (half fluence) has shown good results. Photodynamic therapy (PDT) with verteporfin is an effective treatment with minimal complications. It works even in the chronic variant of the disease and has become a first-line treatment in some centre.
Other treatments include low-dose methotrexate, mifepristone (a cortisol blocker), oral rifampin and in cases of choroidal neovascularization anti-VEGFs therapy.


Complementary Treatment- antioxidants, which reduce oxidative damage and inflammation may play a role in vision improvement. Nutrients such as zeaxanthin, lutein, l-lysine, vinpocetine, specific vitamins & enzymes, and fish oil may help to improve vision in a few patients.
Stress should be eliminated or reduced. Counseling may be done if elevated cortisol is due to life stressors. To reduce stress yoga and meditation may be practiced. The disease shows a strong association with Type A personality types, they should be advised relaxation practice. Another cortisol reduction technique is to undertake some form of breathing practice.

 

 

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