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CASE REPORT
Year : 2014  |  Volume : 2  |  Issue : 3  |  Page : 111-113

Unusual occurrence of central serous retinopathy after head injury


Department of Ophthalmology, MGM Medical College, Navi Mumbai, India

Date of Web Publication7-Sep-2015

Correspondence Address:
Dr. Shrikant Deshpande
Department of Ophthalmology, MGM Medical College, Navi Mumbai
India
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Source of Support: Nil., Conflict of Interest: There are no conflicts of interest.


DOI: 10.4103/2347-5617.164635

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  Abstract 

We report a case of a 28-year-old man who developed central serous retinopathy 2 days after he sustained a contused lacerated wound over the right eyebrow in a road traffic accident.

Keywords: Central serous retinopathy, head injury, optical coherence tomography macular edema


How to cite this article:
Deshpande S, Deshpande M, Dhiware N. Unusual occurrence of central serous retinopathy after head injury. Egypt Retina J 2014;2:111-3

How to cite this URL:
Deshpande S, Deshpande M, Dhiware N. Unusual occurrence of central serous retinopathy after head injury. Egypt Retina J [serial online] 2014 [cited 2019 Mar 22];2:111-3. Available from: http://www.egyptretinaj.com/text.asp?2014/2/3/111/164635


  Introduction Top


Central serous retinopathy (CSR) is a common cause of blurring of vision in young males. Stress and use of steroids are implicated in causation of this condition. However, it is not associated with injury. We are reporting an unusual case of CSR which occurred after a contused lacerated wound over the right eyebrow after a road traffic accident.


  Case Report Top


A 28-year-old Indian man presented to the ophthalmology out patient department (OPD) with a history of diminution of vision in the right eye since 2 days. He was apparently alright 4 days ago, when he was involved in a road traffic accident wherein he fell off his motorbike. He sustained a head injury, and a contused lacerated wound (CLW) measuring 3 cm × 1 cm × 1 cm above the lateral aspect of his right eyebrow. The CLW was sutured by a medical practitioner elsewhere, and X-ray skull antero-posterior and lateral views were taken, which showed no abnormality. The patient was discharged after 24 h of observation. When the patient followed up 2 days for dressing of the wound, he complained of diminution of vision in the right eye, which was attributed to eyelid edema, and the patient was prescribed nonsteroidal anti-inflammatory drugs. The patient noticed worsening of the visual symptoms as the day progressed, particularly for near work and driving.

He presented to the ophthalmology OPD the next day with these symptoms. On examination, unaided visual acuity was 6/24 in the right eye and 6/6 in the left eye. The best corrected visual acuity was 6/9 in the right eye, with a spherical correction of + 0.75D. The pupils were reactive, and no afferent pupillary defect was noted. Visual fields by confrontation were bilaterally normal. Slit-lamp examination revealed a clear lens and quiet anterior chamber bilaterally.

No vitritis was noted. Intraocular pressure was normal in both eyes.

Dilated fundus examination revealed that the right eye had elevated macula due to a large accumulation of fluid. Amsler's charting showed a central scotoma. Optical coherence tomography of the macula revealed increase in macular thickness due to the accumulation of fluid between neurosensory retina and retinal pigment epithelial layer thus confirming the diagnosis of central serous retinopathy (CSR) [Figure 1]. There was no history of any systemic illness, or use of steroids in any form.
Figure 1: Optical coherence tomography picture showing central serous retinopathy

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The patient was counseled regarding the visual prognosis, and prescribed nepafenac 0.1% eye drops 3 times a day for 15 days, and aprazolam 0.25 mg at bedtime to reduce anxiety. He was followed up weekly for a month, and monthly for 2 months. After a period of 3 months, the CSR was found to have regressed, and visual acuity in the right eye was 6/9 unaided.


  Discussion Top


CSR is a circumscribed serous retinal detachment typically affecting the posterior pole, particularly the macular region.[1] It is usually seen in males between 30 and 50 years of age, but has also been reported in older males, and also females. Stress has often been quoted as a predisposition, but may not always be present. There is however, a higher incidence noted in Type A personalities.[2] The use of steroids is now a recognized predisposing factor, especially in cases of organ transplant and other conditions wherein there is a prolonged use of steroids.[3] Increased serum cortisol levels have been reported in patients with CSR.[2] CSR is a relatively benign and self-limiting disorder, which resolves spontaneously within 3-4 months.

To our knowledge, there has been no case of CSR reported after a head injury, and more so in the absence of any ocular trauma. The increase in stress levels due to head injury may have led to the causation of CSR in this patient.

We conclude that CSR may be precipitated by stress caused by head injury, and stress management may be important in people susceptible to CSR to prevent its occurrence.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Liegl R, Ulbig MW. Central serous chorioretinopathy. Ophthalmologica 2014;232:65-76.  Back to cited text no. 1
    
2.
Conrad R, Geiser F, Kleiman A, Zur B, Karpawitz-Godt A. Temperament and character personality profile and illness-related stress in central serous chorioretinopathy. ScientificWorldJournal 2014;2014:631687.  Back to cited text no. 2
    
3.
Loo JL, Lee SY, Ang CL. Can long-term corticosteriods lead to blindness? A case series of central serous chorioretinopathy induced by corticosteroids. Ann Acad Med Singapore 2006;35:496-9.  Back to cited text no. 3
    


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