A welding arc injury can be associated with subretinal fluid, but the thickened choroid in both eyes (as demonstrated by enhanced depth imaging – EDI) strongly points to central serous chorioretinopathy (CSC) as the underlying condition. Further, there are multiple pinpoint spots of hyperautofluorescence, which is more typical of CSC than a welding arc injury. There are “shaggy” photoreceptors on the posterior face of the serous neurosensory detachment and there are disruptions at the level of the RPE, which both indicate a degree of chronicity. It is possible that the patient happened to notice a longstanding visual disturbance when he testing his vision after doing arc welding. Objects appeared more distant with the left eye because the detached and stretched neurosensory retina had greater spacing between photoreceptors. The brain interpreted the resulting image as farther away.
CSC is about four times more common in men than women and is associated with stress and with corticosteroid use. The patient denied significant stress in the recent past and he was not using corticosteroids. Though photodynamic therapy can be very efficacious in this setting, the condition is often self-limited and observation was warranted. The OCT 3 months later demonstrated resolution of the subretinal fluid, and the visual acuity in the left eye improved to 20/25.