Patient With Past Retinal Fluid, Normal Vision Today

An optometrist uploaded this case to Care1

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A patient presented during a routine exam with a past history of “water in the back of the eye” many years ago. Their last exam two years ago showed improvement. Today, visual acuity is excellent with no reported distortion or Amsler abnormalities. The optometrist noted some retinal findings and advised the patient to avoid corticosteroids, manage stress, and consider lifestyle changes.

Care1 Retina Surgeon’s Clinical Insight

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This patient has pachychoroid syndrome and old central serous retinopathy in the left eye. Fundus photography reveals pachydrusen, and OCT imaging shows a thickened choroid. In the left eye, there is a small pigment epithelial detachment (PED) without any associated subretinal fluid. A prominent choroidal vessel is noted beneath the PED, consistent with pachychoroid features. Steroid medications, including topical, nasal, or inhaled forms, should be avoided unless absolutely necessary. No other lifestyle modifications are recommended. Continued observation and follow-up are appropriate, and the Care1 ophthalmologist will remain available to assist with ongoing management.

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‍Care1 AI’s Clinical Insight

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Central serous chorioretinopathy (CSCR) is a retinal disorder characterized by serous detachment of the neurosensory retina due to hyperpermeability of the choroidal vasculature and dysfunction of the retinal pigment epithelium (RPE). It most commonly affects men aged 20 to 50 and presents with acute or subacute central vision changes such as distortion and decreased contrast sensitivity. While the exact cause is unknown, CSCR is strongly associated with corticosteroid use, stress, and increased sympathetic activity. Recurrence occurs in a significant portion of patients, and chronic cases may lead to lasting retinal changes.