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Chapter 029. Disorders of the Eye (Part 16)

Central Serous Chorioretinopathy This primarily affects males between the ages of 20 and 50. Leakage of serous fluid from the choroid causes small, localized detachment of the retinal pigment epithelium and the neurosensory retina. These detachments produce acute or chronic symptoms of metamorphopsia and blurred vision when the macula is involved. They are difficult to visualize with a direct ophthalmoscope because the detached retina is transparent and only slightly elevated. Diagnosis of central serous chorioretinopathy is made easily by fluorescein angiography, which shows dye streaming into the subretinal space. The cause of central serous chorioretinopathy is unknown. Symptoms may. | Chapter 029. Disorders of the Eye Part 16 Central Serous Chorioretinopathy This primarily affects males between the ages of 20 and 50. Leakage of serous fluid from the choroid causes small localized detachment of the retinal pigment epithelium and the neurosensory retina. These detachments produce acute or chronic symptoms of metamorphopsia and blurred vision when the macula is involved. They are difficult to visualize with a direct ophthalmoscope because the detached retina is transparent and only slightly elevated. Diagnosis of central serous chorioretinopathy is made easily by fluorescein angiography which shows dye streaming into the subretinal space. The cause of central serous chorioretinopathy is unknown. Symptoms may resolve spontaneously if the retina reattaches but recurrent detachment is common. Laser photocoagulation has benefited some patients with this condition. Diabetic Retinopathy A rare disease until 1921 when the discovery of insulin resulted in a dramatic improvement in life expectancy for patients with diabetes mellitus it is now a leading cause of blindness in the United States. The retinopathy of diabetes takes years to develop but eventually appears in nearly all cases. Regular surveillance of the dilated fundus is crucial for any patient with diabetes. In advanced diabetic retinopathy the proliferation of neovascular vessels leads to blindness from vitreous hemorrhage retinal detachment and glaucoma see Fig. 338-9 . These complications can be avoided in most patients by administration of panretinal laser photocoagulation at the appropriate point in the evolution of the disease. For further discussion of the manifestations and management of diabetic retinopathy see Chap. 338. newpage Retinitis Pigmentosa This is a general term for a disparate group of rod and cone dystrophies characterized by progressive night blindness visual field constriction with a ring scotoma loss of acuity and an abnormal electroretinogram ERG . It occurs sporadically