Central Serous Retinopathy

Central Serous Retinopathy

About the Condition

Central serous retinopathy is an eye condition which builds up fluid behind the retina, a thin sensitive tissue layer behind the eye responsible for converting light into neural signals that are sent the brain and helps you recognize images perceived by the eyes.

The fluid build-up affects the vision and may cause a partial detachment of the retina resulting in a sudden or gradual loss of vision to affected individuals.

This condition, also medically known as central serous chorioretinopathy (CSC), can correct itself (drain the fluid on its own) over time without the need for medical intervention. However, to increase the chances of a complete recovery and prevent the risk of permanent damage to your vision, it is better to seek medical advice and have yourself checked and diagnosed at the onset of changes in your vision.

Retinopathy

Symptoms

Usually, central serous retinopathy is present in only one eye, although there are cases where the condition manifests in both. The initial symptom of central serous retinopathy is the blurring of vision in one eye, which can also be accompanied by the dimming of vision in that same eye.

CSC may also show the following symptoms:

  • Your central vision may exhibit some darkness
  • You may perceive straight lines as crooked
  • You may have problems with depth perception, such as perceiving objects to be farther than they really are.
  • You might see white objects having a brownish or greyish tint

These symptoms depend on the location of the fluid buildup. In some cases, there may be no change in your vision such as when the macula in your retina is not affected. The macula is the part of the retina responsible for seeing the fine details of an object, and if it is unaffected by CSC you may continue to see objects with detail.

Risk Factors and Causes

Possible causes and risk factors for developing central serous retinopathy include the following:

1. Age and Gender

Central serous retinopathy is very prevalent among men aged 30 to 60 years. This is unlike other eye diseases which usually strike late in your life. Although women can also develop CSC, men are more likely to exhibit the condition.

2. Stress

Stress is another major risk factor for CSC. Cortisol levels are heightened during stressful situations, which can cause eye inflammation and fluid leakage behind the retina. Several studies have been made that link high-stress levels with central serous retinopathy.

3. Steroids

Taking corticosteroids and other steroid drugs increase the levels of cortisol in the body. This increases the risk of developing CSC.

The exact causes of CSC are still unknown, and it is important to stay healthy and lower the risks of developing it by being aware of the risk factors given above.

4. Having the condition in the past

Studies have shown that persons who have had CSC and have recovered from it are more likely to develop it again in the future. In fact, if CSC recurs, it may need more aggressive treatment. If you have previously recovered from CSC, it is recommended to meet with your eye doctor at least once a year to monitor your eye’s health.

Treatment Options

diagnostic office

Usually, there is no need for treatment since the fluid behind your retina will go away on its own in a few months. To ensure that the fluid is, in fact, draining away, you may consult with an ophthalmologist.

In cases where fluid build-up doesn’t drain on its own, these are the different types of treatment and CSC management options available:

1. Prescription Medication

Your eye doctor may prescribe you some medication that can help with CSC. One such drug is an anti-vascular endothelial growth factor (anti-VEGF) medicine. This helps to prevent new blood vessels in the eye from growing, which can often cause further problems with your vision.

It is usually recommended to avoid drugs containing steroids, such as corticosteroids, which raise cortisol levels. However, some serious complications could stem from the sudden stoppage of steroid therapy so make sure to consult with your eye doctor beforehand.

2. Photodynamic Therapy

This procedure primarily aims to stop the leaking from the fluid build-up behind the retina.

Photodynamic therapy is performed by injecting your arms with verteporfin, a drug specially designed to correct blood vessels in the eyes. To stop the leaking the verteporfin is activated by a cold laser that is  focused on the leaking fluid build-up around the eyes. This procedure can also prevent leaks in the future.

3. Thermal Laser Treatment

Thermal laser treatment can also help stop the leak by sealing the tissue of the leaking fluid behind the retina. However, compared with photodynamic therapy, conventional thermal laser treatment procedure poses a greater risk of complications and side-effects such as scarring. So better discuss your options with your doctor first to ensure optimal treatment as well as your safety.

4. Lifestyle Changes

Some lifestyle changes you can do to help treat or prevent CSC include the following:

  • Avoiding or reducing your caffeine intake. Caffeine raises cortisol levels in the body which have been linked to central serous retinopathy.
  • Getting enough sleep. Research has shown that people with irregular sleep patterns and other sleep disorders are more likely to develop CSC. At least seven hours of sleep per day is recommended.
  • Avoiding or reducing alcohol consumption. Increased alcohol consumption is considered one of the many risk factors for CSC.
  • Managing stress levels. Experiencing stress raises cortisol levels in the body which increase the risk of developing SCR. Activities such as meditation and yoga can help manage your stress levels.

When to Schedule for a Check-up

Schedule an appointment with your eye doctor right away if you notice any changes in your vision. Do not put it off to some other day or wait for your next pre-scheduled appointment because some eye conditions may rapidly worsen and result in permanent loss of vision if you do not take them seriously.

In some cases, your doctor may recommend a watch-and-wait approach to treat your central serous retinopathy. During this time, it is important to know that you should be able to observe improvements within a few months. If the condition worsens or does not go away on its own over time, discuss with your doctor the different treatment options you can get like photodynamic therapy or laser treatment depending on what is most suitable and safest for you.

Final Thoughts

It is important to take note that even if you’ve recovered from CSC, the chances of developing it again is very high and will need much more aggressive treatment to recover. It is vital that you talk to your doctor regularly for maintenance and monitoring. If you plan to take medication containing steroids, determine first from your eye doctor if it is safe.

Remember the different risk factors stated previously and always maintain a healthy lifestyle so as to avoid the higher risks of developing central serous retinopathy and other eye conditions. Add activities such as yoga and meditation to your day to help manage your stress levels. Going to regular checkups and consultations with your eye doctor can help you be aware and prepared for possible risks of developing the condition.

Childhood Glaucoma

Childhood Glaucoma

What is it?

Childhood glaucoma is a disease associated with increased eye pressure resulting in optic nerve damage. From the name itself, this condition occurs in babies and young children and are usually categorized into different types depending on the age of onset.

Know more about the different types of childhood glaucoma, its associated risk factors, diagnostic procedures and available treatment options in the following sections.

Types of Childhood Glaucoma

Oftentimes, the type of childhood glaucoma can be based on the child’s age. These types include:

  • Primary Congenital Glaucoma – manifested at birth
  • Infantile Glaucoma – developed at age 1-24 months
  • Juvenile Glaucoma – onset 2 years after birth

In addition to age, the abnormality of eye structure and related medical conditions provide a more appropriate way to determine the type of glaucoma.

glaucoma

Symptoms of Childhood Glaucoma

The three most common symptoms of childhood glaucoma are abnormally enlarged eyes, increased sensitivity to light and corneal cloudiness. In some cases, secondary glaucoma can develop and can be influenced by numerous factors.

What is Secondary Glaucoma?

Secondary glaucoma is a medical condition where the glaucoma is associated with a secondary cause like certain types of disease and disorders.

Causes of Secondary Glaucoma

1. Eye Disorders during Childhood

Certain eye disorders that occurred during childhood can cause secondary glaucoma. For instance, children who have had the following conditions are at higher risk to developing glaucoma as they age:

  • prolonged use of steroidal eye drops to treat associated eye inflammations like juvenile rheumatoid arthritis
  • their genetic cataracts removed early in their life

2. Systemic Diseases

Systemic diseases are diseases that affect the whole body, this can be a cause for secondary glaucoma. The following systemic diseases are usually associated with secondary glaucoma:

  • Neurofibromatosis- a genetic disorder that mainly affects the nerve cells
  • Aniridia-characterized by partial or complete absence of the iris
  • Axenfeld-Rieger syndrome- a disorder that primarily affects the frontal area of the eye and in some cases, other parts of the body
  • Sturge-Weber syndrome- a rare condition caused by brain abnormalities and usually affecting one side of the face

3. History of Eye Trauma

A child with a history of eye trauma can also develop glaucoma during his/her childhood. However, in some cases, glaucoma does not manifest until the child reaches a certain age. This is why doctors recommend regular eye screening for children who have experienced eye trauma in their childhood for early detection of secondary glaucoma.

Early Detection is Key

Even though glaucoma is widely known as a disease occurring in adults, children at a very young age can be very vulnerable to developing this condition. To prevent irreparable damage later in life, early detection of childhood glaucoma is key.

In this light, for the remaining sections, this article will focus on the type of glaucoma present at birth which is medically known as primary congenital glaucoma.

What is Primary Congenital Glaucoma?

Primary congenital glaucoma is a relatively rare disease (1 in 10,000) manifested at birth. When the pediatrician or the parents observe eye abnormalities on newborn babies, these affected infants are promptly referred to be screened by an ophthalmologist.

Prominent eye abnormalities may include:

  • Abnormally enlarged eyes
  • The round, dark part of the infant’s eye is larger than usual
  • Corneas appear cloudy or opaque
  • Increased photosensitivity (light sensitivity)
  • Excessive blinking
  • Having excessive tears

It is important to note that not all excessive tearing is a sign of congenital glaucoma. This is because excessive tearing associated with the obstruction of tear ducts is generally more common than primary congenital glaucoma in infants.

To avoid confusion of the symptoms, excessive tearing caused by tear duct obstruction is often accompanied by discharge and crusting. Therefore, without discharge and crusting, the excessive tears can be an indication of congenital glaucoma.

Diagnostic Procedures

In the case where there is a chance of primary congenital glaucoma, an examination under anaesthesia is done along with relevant surgeries. Unlike adult glaucoma where eye drops or laser treatments are considered for first-line treatments, primary congenital glaucoma is generally considered a disease and requires early surgery. As the baby is undergoing the examination, surgery is also performed to avoid having the baby endure the anaesthesia twice.

For the diagnosis of primary congenital glaucoma, the ophthalmologist does the following:

  • Measures the eye pressure of the baby
  • Inspects the whole eye of the baby, which includes the optic nerves and drainage angle
  • Checks if the baby’s cornea is clear or cloudy
  • Measures the cornea size of the baby
  • Measures the baby’s eye size (as the eyeball is larger than normal in the case of congenital glaucoma)

When the child gets older, these examinations are done in the clinic instead of the operating room and are done similarly to adult examinations. At this stage, diagnostic procedures include the use of visual field tests and optic nerve imaging.

Treatment Options

Baby rubbing it's eyes

Several types of surgeries may be performed for primary congenital glaucoma. These include:

  1. Goniotomy

Goniotomy is a surgical procedure done to open an eye’s drainage systems. This is done via the use of a special lens called a goniolens to be able to see the structures on the front of the eye or anterior chamber. A small hole is then made in the trabecular meshwork, which is the group of small canals located in the drainage angle. This then allows fluid to leave the eye.

  1. Trabeculotomy or Trabeculectomy

A trabeculotomy is a surgical procedure done to lower the eye pressure by making a small hole in the eye. A trabeculectomy is the same procedure except that the hole is made with the removal of tissue.

  1. Tube Shunt Surgery

Tube-shunt surgery is performed to help lower eye pressure and is done by inserting a tube in the front of the eye.

Both goniotomy and trabeculotomy surgeries are done to open the eye’s drainage systems and have shown success in the treatment of primary congenital glaucoma. Trabeculectomy and Tube-shunt surgery are also performed on adults with glaucoma and are performed to lower eye pressure.

Although surgeries for primary congenital glaucoma have shown to be very successful, the child will need routine checkups as the eye pressure may start to increase over time. To get the eye pressure under control, multiple examinations and procedures are needed to be done.

Eye drops are still prescribed even for highly successful surgeries to keep the eye pressure optimal. There is also a chance for the child to develop nearsightedness due to the larger eyeball size and will need glasses. Some children also develop amblyopia (lazy eye) or strabismus (crossed eyes)  which will impair their vision and require further treatment from a pediatric ophthalmologist.

Important Things to Know

Based on numerous reports and studies, children who developed glaucoma can lead healthy and fulfilling lives. However, because glaucoma can start to manifest early in life, significant (sometimes permanent) vision damage can be expected as the child grows older.

This is why early diagnosis and treatment of childhood glaucoma is very important as it can have a great impact on the child’s life. Proper monitoring and dedication to treatment are important keys to achieve better outcomes and improve the management of childhood glaucoma.

While lost vision cannot be regained, the remaining vision of each child can be optimized and maximized with the help of the child’s doctor and the support of the parents and the child’s community.