56 yo male presents with a decrease in their vision over the past 2-3 days. Vision loss is described as a central loss of color vision (area appears gray). No vision or color loss in the periphery is described.
On exam, his vital signs are are normal. You attempt to perform a funduscopic examination, but are unable to adequately visualize the retina. A bedside ultrasound is subsequently performed and the following clips are obtained:
What do the clips show? What is the diagnosis? (Click the button for the answer!)
Central Serous Chorioretinopathy
Bedside ultrasound does not demonstrate an obvious retinal or vitreous detachment. However, there is a small area of edema identified in the region of the macula. This prompted further evaluation by an ophthathalmologist. On their examination, they were able to visualize a large area of edema involving 80% of the macula.
- Central serous chorioretinopathy occurs when there is a localized serous detachment of the neruosensory retinal involving the region of the macula without sub retinal blood or lipid exudates. It is usually unilateral and most often affects young or middle-aged men. 1
- Patients may complain of unilateral blurred vision, scotoma in the central visual field, image distortion (metamorphosis), micropsia (reduction in the apparent size of objects), mild dischromdtopsia (abnormal color perception) and reduced contrast sensitivity. Some cases, however, may be asymptomatic. 1
- The natural course of CSC is often self-limiting with complete fluid reabsorption often occurring1
- However, lasting visual symptoms can occur, including localized distortion, reduced color discrimination and decreased night vision1
- Most often CSC occurs as an isolated event, however recurrence can occur in 30-50% of patients1
- To the knowledge of this author, this is the first case report of emergency physician-performed ultrasound in the diagnosis of central serous chorioretinopathy
- Diagnosis is traditionally confirmed by optical coherence tomography (OCT), fluorescein and/or indocyanine green (ICG) angiography, and optical coherence tomography angiography (OCTA). 1
The following image demonstrates an OCT of a central serous chorioretinopathy:
Authors: Jacob Avila, MD
Peer Reviewer: Ben Smith, MD, FACEP
References
- Semeraro F, Morescalchi F, Russo A, et al. Central Serous Chorioretinopathy: Pathogenesis and Management. Clin Ophthalmol. 2019;13:2341-2352. PUBMED
