The patient was a 31-year-old man who had blurred and dark vision in his left eye for 8 weeks. He first noticed a change in vision after doing arc welding. He had proper eye-protective gear at the time, and he did not notice a flash injury. The visual acuity was 20/25 OD and 20/50 OS. He said that objects appear farther away when looking with the left eye. What is the most likely diagnosis? What treatment, if any, would you recommend?
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.
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.
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