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42 yo patient comes with blurring of right eye It started 2 months ago, no pain, no photosensitivity, no pain in eye movement, constant blurring, no dropping, no injury, patient works at normal place, patient has controlled hypertension with meds , no Diabetes Mellitus, no autoimmune disease, no hemorrhage in sclera is seen. Blurring is central Visual acuity for Right eye 20/100 Left eye is 20/30 No keratitis noted Cornea is clear

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"central serous chorioretinopathy"

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AAO painless central vision loss unilateral evaluation OCT dilated retinal examination

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This presentation is most suggestive of a macular disorder, with central serous chorioretinopathy (CSCR/CSR) high on the differential:
  • Typical profile: unilateral, painless, persistent central blur in a young or middle-aged adult
  • CSCR often causes central blurring, image distortion, micropsia, and mild color change
  • Systemic hypertension is an associated risk factor. Ask specifically about any corticosteroid exposure: oral, inhaled, nasal spray, skin cream, joint injection, bodybuilding products, or endogenous Cushing syndrome. Stress and sleep apnea are also associations. Kanski's Clinical Ophthalmology, p. 602.
However, 20/100 vision for 2 months requires prompt retinal assessment, not presumptive treatment. A clear cornea and absence of keratitis make a corneal cause unlikely. Absence of pain with eye movement makes typical optic neuritis less likely, but does not exclude optic-nerve disease.

Important alternatives to rule out

  1. CSCR with subfoveal fluid - leading possibility.
  2. Macular edema, including hypertension-related retinal vascular disease or retinal vein occlusion.
  3. Epiretinal membrane, vitreomacular traction, or macular hole.
  4. Optic neuropathy, including nonarteritic ischemic optic neuropathy, particularly with vascular risk factors.
  5. Less likely: uncorrected refractive error or early cataract, but these should be checked with refraction and pinhole acuity.

Next steps

Arrange an ophthalmology or retina appointment within days, ideally urgently this week, for:
  • Best-corrected acuity and pinhole/refraction
  • Pupils, including relative afferent pupillary defect
  • Color vision and visual-field testing
  • Dilated retinal and optic-disc examination
  • Macular OCT of both eyes. OCT is key for detecting subretinal fluid, macular edema, traction, membrane, or a macular hole.
  • Fundus photography, with fluorescein angiography or OCT angiography if indicated
  • Intraocular pressure and review of blood-pressure control
Central vision loss can arise from macular disease, macular edema, vascular occlusion, optic neuropathy, and CSCR, among other causes, as summarized by the American Academy of Ophthalmology.

Safety-net

Send for same-day emergency eye care if there is sudden worsening, a curtain/shadow, new flashes or many floaters, severe headache or neurologic symptoms, or a marked color-vision change.
Do not start or stop steroid-containing medicines without the prescribing clinician, but tell the eye specialist about every steroid product being used. Recent evidence includes a 2025 Cochrane systematic review of CSCR interventions (PMID: 40522203); treatment selection depends on OCT findings and whether fluid is persistent or recurrent.
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