The Dilemma of Central Serous Retinopathy, a Corticosteroid-induced Complication, in Patients with Ocular Inflammatory Disease

Abstract

To the Editor: Rheumatologists sometimes collaborate with ophthalmologists in the management of patients with ocular inflammatory disease. Corticosteroids are often a valuable component of this management. Ophthalmic complications associated with corticosteroid usage include cataract and glaucoma. Corticosteroids have also been implicated in another important cause of visual loss, central serous retinopathy (CSR)1,2, a disorder characterized by neurosensory detachment of the retina affecting the macula. The combination of CSR, best managed by reduction in corticosteroid dosage, and inflammation usually requiring increased corticosteroid dosage creates a dilemma such that worsening visual acuity should be treated paradoxically with reduction in corticosteroid dosage. A 34-year-old male patient with history of juvenile idiopathic arthritis and uveitis complained of blurred vision in the left eye for 3 days, which was 3 weeks after increasing prednisone dose to 10 mg daily. He was functionally blind in the right eye due to band keratopathy. Vision was 20/25+2 in the left eye. The fundus examination revealed CSR, confirmed by ocular coherence tomography (OCT; Figure 1) and fluorescein … Address correspondence to Dr. S.R Gupta, 3375 SW Terwilliger Blvd., Portland, Oregon 97239; E-mail: seema\_r\_gupta{at}yahoo.com