The fundus photo of the left eye shows pigmentary disturbances in the temporal juxtafoveal area, and there is a surrounding neurosensory detachment. The OCT of both eyes shows a markedly thickened choroid, and OCT of the left eye reveals a neurosensory detachment with elongated photoreceptors. There is no evident retinal pigment epithelial detachment. The OCTAs (not pictured) were unremarkable and did not show evidence of choroidal neovascular membrane activity. The fluorescein angiogram shows a “hot spot” in the temporal foveal area with mild leakage into the subneurosensory space.
The recognition of a visual disturbance while welding suggests a welding-arc injury, and such injuries can be associated with neurosensory detachments. However, evidence favoring a diagnosis of central serous chorioretinopathy are the following: the patient said that he was using proper eye protection at the time, the OCT reveals thickened choroids in each eye, the patient was a young man, he had a history of significant stress, and the fluorescein angiogram shows pinpoint leakage from a “hot spot". The correlation between welding and the visual disturbance was likely related to his discovering decreased vision in the left eye while doing an activity that habitually had relied on the left eye.
Because of the foveal location of the hot spot, thermal laser was not an option. The subretinal fluid failed to resolve after several months, and the patient decided to proceed with photodynamic therapy. This treatment proved efficacious, and the subretinal fluid resolved. The visual acuity improved to 20/25, but the patient related that images were not as sharp and colors seemed “washed out” when he covered the right eye.
