What happens in the eye
Below the retina there is a layer of pigment epithelium that works like a pump: it constantly pumps out the fluid leaking from the choroid. With this disease, the choroidal vessels dilate and begin to let more fluid through, and the pump in one or more places stops coping. Fluid accumulates under the center of the retina and lifts it. The photoreceptors move away from the feeding layer, so vision in this area deteriorates. If the detachment persists for a long time, the cells become thinner and the changes become irreversible.
- Acute form - up to 3-4 months, often goes away on its own
- Chronic form - fluid lasts longer
- Relapsing course with repeated episodes
- Possible detachment of the pigment epithelium
- Long-term detachment leads to photoreceptor atrophy
Causes and risk factors
The exact mechanism is not fully understood, but the role of stress hormones is considered key. That is why the disease more often occurs in men of active age during periods of high stress and lack of sleep. It is especially important to take glucocorticoids in any form: tablets, injections, ointments, nasal drops - this is a recognized provoking factor. Contributors include hypertension, sleep apnea, infection with the bacterium H. pylori, and pregnancy, in which the disease usually resolves after delivery.
- Taking glucocorticoids in any form
- Chronic stress and lack of sleep
- Male gender, age 30–50 years
- Arterial hypertension
- Obstructive sleep apnea syndrome
- Pregnancy
Symptoms
The disease almost always begins in one eye. There is a sensation of a cloudy or dark circle right in the center of the gaze, which does not go away when blinking. It is very characteristic that objects with this eye appear smaller in comparison with the second, and colors appear duller and yellowish. Straight lines look slightly curved, and letters blur when read. It is often noted that for clarity it is necessary to move the text slightly further than usual. There is no pain, redness or discharge, peripheral vision is completely preserved.
- Blurry or dark spot in the center of the field of view
- Objects appear smaller than they really are
- Curvature of straight lines
- Dull and yellowish colors
- Reducing image contrast
- No pain or redness
Diagnostics
The key method is optical coherence tomography: it clearly shows the cavity with clear fluid under the retina, measures its height and allows you to monitor resorption without additional procedures. When examining the fundus, the doctor sees a slightly raised area with an altered reflex. Angiography helps determine the point of leakage if laser treatment is planned and distinguishes the condition from wet macular degeneration, which is especially important in patients over fifty years of age. The doctor must clarify whether the patient is taking hormonal medications.
- Optical coherence tomography of the retina
- Fundus examination with pupil dilation
- Amsler test for self-control
- Fluorescein angiography in treatment planning
- Collection of data on glucocorticoid intake
- Blood pressure monitoring, sleep quality assessment
Treatment
For the first episode, observation is usually chosen: for most, the fluid resolves on its own within one to four months, and vision returns. The most important measure is, in consultation with your doctor, to stop taking glucocorticoids, if prescribed, and reduce stress levels, improve sleep, treat apnea and hypertension. If the detachment persists for more than three to four months or the episodes recur, photodynamic therapy or gentle laser treatment of the leakage point is used. Diuretics, vitamins and vascular drugs have no proven benefit. You cannot cancel hormonal medications prescribed for another disease on your own.
- Observation with OCT control at the first episode
- Cancellation or replacement of glucocorticoids only together with the prescribing doctor
- Normalization of sleep and reduction of stress levels
- Treatment of hypertension and sleep apnea
- Photodynamic therapy or laser for chronic form
- Self-control using the Amsler test
