37-year-old pregnant woman with hypertension has blurry and distorted vision
What is your diagnosis?
The diagnosis is...
The image is consistent with a diagnosis of central serous retinopathy.
What is the role of the primary care or emergency medicine physician?
The clinical presentation of central serous retinopathy is nonspecific (eg, blurry vision, dimming of light, distorted depth perception), and steps to a diagnosis must be taken.
- Primary care and emergency medicine physicians should obtain a full history to rule out other serious causes of diminished visual acuity.
- The differential diagnosis includes retinal detachment, neovascular exudative age-related macular degeneration, and retinal venous occlusion.
- Primary care and emergency medicine physicians should refer patients to ophthalmology for further management and evaluation.
What is the role of the ophthalmologist?
- The ophthalmologist should perform a dilated fundus examination to view the retina and rule out emergent causes of vision loss.
- Next, an optical coherence tomography (OCT) scan should be taken to better visualize and locate the fluid collection along the retina.
- Figure A on the right shows an early-phase fluorescein angiogram of a patient with central serous retinopathy, whereas figure B shows a late-phase fluorescein angiogram.
- Figure C on the right is an OCT showing the retinal fluid collection (orange arrow).
What is the treatment?
- Central serous retinopathy often resolves in 1-2 months without treatment.
- Laser treatment, photodynamic therapy, or oral medications may be used in severe or persistent cases.
- Cases occurring in pregnancy often resolve after delivery.
- Vision may not fully resolve back to baseline.
- Long-term ophthalmology follow-up is warranted, due to the risk of permanent vision loss from persistent fluid accumulation.
Learn more: Ophthalmology resources for medical students