central serous chorioretinopathy melbourne

Central Serous Chorioretinopathy – Causes, Symptoms, and Treatment

The retina of the eye is a complex structure, composed of ten layers of different cell types that work together to sense light incoming from the external visual environment, convert it into a neural impulse, and send this signal onward to the visual processing centres of the brain for perception and interpretation. Disruption to any of these retinal layers, whether from disease or trauma, has the potential to affect our vision. In some cases we may not even be aware of changes to our vision while in others, such as during central serous chorioretinopathy (or CSCR), it can be quite obvious that something is not right. 

 

What is Central Serous Chorioretinopathy?

Also known as central serous retinopathy, central serous chorioretinopathy is a retinal condition characterised by the accumulation of serous fluid beneath the sensory retina, resulting in detachment from the underlying layers.

As the name suggests, this fluid accumulation tends to occur around the macula, which is responsible for our central vision. Because the macula is the most sensitive part of our vision that we use to discern fine detail such as text and colour, distortion to the retinal tissues in this area is often easily apparent, however, some people with central serous chorioretinopathy may be slow to become aware of any issue, particularly if the affected eye is the non-dominant one, or if the swelling happens to occur slightly further away from the macula where we’re less attentive to changes. 

The exact underlying causes of central serous chorioretinopathy are not fully understood but is thought to be a result of some sort of dysfunction of the blood vessels underlying the retina in the vascular choroid layer, or impairment of another supporting layer called the retinal pigment epithelium (RPE), which permits too much fluid to cross its cells. The ultimate result is leakage and accumulation of serous fluid from the blood vessels beneath the sensory retina, causing a swelling and distortion of the overlying tissues. 

Central serous chorioretinopathy is much more common in men than in women, about 6 times more frequent, and typically affects those between 20 and 45 years of age. 

Certain risk factors are associated with the development of central serous chorioretinopathy, including:

  • Steroid medications, which can include steroid tablets, creams, injections, or even nasal sprays 
  • Emotional and psychological stress
  • Type A personalities (those who tend to be competitive, impatient, and anxious; possibly associated with high-stress behaviours)
  • Pregnancy
  • Sleep disturbances, such as sleep apnoea or insomnia
  • Hypertension 

Because central serous chorioretinopathy involves a swelling of the retina, vision in that particular area of the eye is distorted. It may be difficult to describe the experience exactly, as not all people with the condition feel that the vision is necessarily “blurry”.

risks factors central serous chorioretinopathy melbourneWhile some may report that their visual acuity is perceived to be decreased, they may also describe the sensation as:

  • Feeling as if the vision is distorted, that straight lines appear wavy or bent
  • A dark or dimmed patch in the vision
  • Objects in the affected eye appearing smaller or further away than when viewing with the other side
  • A disturbance to the colour vision in the affected eye, such as colours appearing unusually dull 

 

Treatment

Your eyecare practitioner, whether an experienced optometrist or ophthalmologist, is able to diagnose the presence of central serous chorioretinopathy by viewing your retina with various techniques, including:

  • Fundoscopy (directly assessing the retina with a light and biomicroscope)
  • Fluorescein angiography (involving intravenous injection of a fluorescent dye to view areas of fluid leakage in the retina)
  • Optical coherence tomography (a non-invasive scan that allows visualisation of the outer layers of the retina)

Many cases of central serous chorioretinopathy will self-resolve over a few months without any intervention or need for retinal surgery. It helps to be able to identify and address any underlying factors, such as stress or the use of steroid medications. 

In select situations, you may be referred to an eye specialist familiar with retinal surgery and managing retinal conditions. Such cases include those that are taking too long to self-resolve, chronic cases, frequently recurrent cases, or for patients who suffer existing poor vision in the other eye or have some other reason for requiring a rapid recovery. 

Certain patients may be recommended oral medications as select groups of people with central serous chorioretinopathy have been found to respond well to this, however, these will not be suitable for everyone. If your eye specialist considers your condition to be a good candidate for retinal surgery, you may be offered either laser photocoagulation or photodynamic therapy. Laser photocoagulation has been shown to be able to speed up the resolution of central serous chorioretinopathy by up to 2 months. During this retinal surgery technique, a targeted laser is used to induce controlled tissue scarring that works to seal the detachment around the macula while allowing surrounding healthy retinal pigment epithelium tissue to pump away the excess fluid.

Photodynamic therapy also involves the use of a laser, this time to activate an intravenously injected drug that accumulates in the abnormal blood vessels of the eye. Activation of this drug reduces leakage from these vessels and has been demonstrated to decrease fluid accumulation and improve the vision. As with many laser therapies, both laser photocoagulation and photodynamic therapy carry the risk of potential adverse effects. These may include small patches of permanent vision loss from retinal scarring or the induction of the growth of new blood vessels. Your eye specialist is the best person to assess these risks and will only recommend you undergo such therapies if the benefits outweighed the likelihood of encountering further complication from treatment.

 

 

 Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

how to get rid of a chalazion melbourne

How to Get Rid of a Chalazion? What Is It and What You Can Do About It?

Chalazion is not a word you hear very often, despite being a reasonably common eyelid bump. Many people in fact don’t realise they have a chalazion on the eyelid, instead believing that painless lump is called a stye. In fact, the two are technically different conditions, although there are some similarities in how to get rid of a chalazion to how you get rid of a stye. Fortunately, both tend to be managed successfully with conservative home remedies without requiring referral to an oculoplastic surgery specialist

 

The Difference Between a Chalazion and a Stye

Before understanding how to get rid of a chalazion, it’s important to understand how it differs from a stye. A stye is also known as a hordeolum, and is an active infection of one of the glands of the eyelid, typically by the staphylococcus family of bacteria. On the other hand, a chalazion is non-infective, and is instead caused by a blockage of the sebaceous oil glands within the eyelid that contribute to the tear film of the eye, known as the meibomian glands. The meibomian glands line both the upper and bottom eyelids, and secrete their oils called meibum, onto the surface of the eye from tiny orifices along the eyelid margin just behind the eyelashes. 

When a meibomian gland becomes obstructed, meibum accumulates behind this blockage, causing a swollen lump that we then identify as a chalazion in the eyelid. Initially, this lump may be a little tender to touch and slightly red, but within a few days resolves to a painless, firm bump on the eyelid that can persist for weeks. Conversely, a stye typically presents as a yellowish or whitish pimple-like bump next to an eyelash, associated with pain and inflammation for a few days before it naturally ruptures and drains its contents. One of the most important differentiating factors to remember between a chalazion and a stye is that a chalazion does not involve any active infection whereas a stye does. 

 

How to Get Rid of a Chalazion?

factors how to get rid of a chalazion melbourneReferral for oculoplastic surgery is rarely warranted for chalazia (the plural of chalazion), and is only required for very large or persistent bumps. Initially, your eyecare provider or GP will most likely suggest conservative therapy in the form of a simple hot compress over the affected eyelid, as the heat will help to speed up the body’s natural process of resolving the chalazion by reducing the blockage obstructing the meibomian gland and clearing away the accumulated waste material. There are no prescribed guidelines for how long or how often you should apply the warm compress – anywhere from 2 to 5 times a day, 5 to 10 minutes at a time can be appropriate. It is important that you never try to pop or squeeze the bump as doing so may spark an inflammatory reaction as the contents of the chalazion are spread through the soft tissues through force.

If you break the skin while trying to pop the chalazion, you may also risk causing yourself a bacterial infection. Even without using a hot compress, a chalazion will self-resolve eventually, typically within a few weeks to a couple of months.

Because a chalazion is not an active infection, antibiotics are ineffective and should not be taken. If your eyelid bump is diagnosed as a stye, topical or oral antibiotics may be recommended as there is an actual bacterial infection that can respond to antibiotic treatment; this being said, many styes will self-resolve within a few days without intervention. 

In some cases, your optometrist or GP may recommend you see an ophthalmologist experienced in oculoplastic surgery. Such situations may involve chalazia that are very large, causing issues with appearance that the patient finds distressing, or chalazia that are located centrally along the eyelid and are large enough to press on the eyeball, causing distortion of the cornea. The cornea is the transparent dome of tissue at the very front surface of the eye and if even slightly distorted from the pressure of the chalazion, can cause temporary blurred vision in that eye.

Occasionally, chalazia can also take a very long time to self-resolve, sometimes lasting for several months. Although it is safe to simply ignore it and allow it to heal slowly by itself, some people may prefer instead to undergo oculoplastic surgery for an immediate resolution. This is typically in the form of a procedure known as incision and curettage, which involves making a small cut into the eyelid under local anaesthesia and scooping out the contents of the blocked gland. Another option the eye specialist may recommend is the injection of a steroid into the chalazion to reduce its size and speed up resolution. 

Chalazia can recur, particularly if you have an underlying condition that causes you to be more prone to encountering them in the first place. Skin and eye conditions that affect the function of the meibomian glands such as acne rosacea or meibomian gland dysfunction can increase your risk of experiencing recurrent chalazia (and styes). Keeping these underlying conditions under control can reduce your risk of recurrent chalazia. Occasionally, a frequently reoccurring chalazion, particularly one that always pops up in the same place on the eyelid, may be indicative of a more serious disease, such as skin cancer. If your eye specialist suspects this, he or she will perform a biopsy on the bump to rule out any malignancy. 

 

 

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.