View Abstract

A1261 - “Doc, I Can’t See!” Acute Monocular Vision Loss from Prednisone, a Rare but Important Complication
Author Block: D. Golovyan1, D. WuDunn2, M. O. Farber3; 1Division of Pulmonary and Critical Care, Indiana University, Indianapolis, IN, United States, 2Department of Ophthalmology, Indiana University, Indianapolis, IN, United States, 3pulmonary/ccm, indiana university school of medicine, Indianapolis, IN, United States.
Introduction: Pulmonary and critical care doctors frequently prescribe systemic corticosteroid medications. Although considered generally safe, well known adverse effects of short term use include psychiatric disturbances and avascular necrosis. Long term adverse reactions are numerous and include fat redistribution, diabetes, osteoporosis, glaucoma and cataracts. In addition to these well-known adverse reactions, less common adverse effects occur, and require timely recognition by the prescribing physician.
Case report: a 38 year old man with emphysema presented to pulmonary clinic complaining of increased cough with change in the amount and quality of his sputum. He was treated with a 3 day course of azithromycin and a 5 day course of prednisone at 40mg daily. On the third day of his treatment he called complaining of acute monocular vision loss. He described increased blurriness in his right visual field, as well as blurriness when closing his left eye. He was convinced it was an adverse reaction to prednisone. He was urged to seek emergency care and reassured that while systemic corticosteroids can increase long term risk of visual problems they are not known to cause acute visual deficits. He did not present to the ED, but continued to complain of blurry vision and was set up with an urgent appointment with ophthalmology. Dilated eye exam was normal in the left eye, but revealed subretinal fluid under right fovea. Optical coherence tomography (OCT) confirmed presence of subretinal fluid with a choroidal thickness of 261um. He was diagnosed with central serous chorioretinopathy (CSCR) and managed conservatively with discontinuation of prednisone and close follow up. One month later, his visual acuity had improved and choroidal thickness reduced to 207um. He had a complete recovery of his vision over the following month.
Discussion:
Central serous chorioretinopathy is an uncommon type of retinal detachment that has a well described association with systemic corticosteroids. Diagnosis can be made with an ophthalmologic examination, OCT can be used to confirm subretinal fluid and increased choroid thickness. The mainstay of treatment is reduction or stoppage of systemic corticosteroids, if it can be safely accomplished. Chronic forms are rare, and the condition is generally self-limiting with complete visual recovery common within 3 months of symptoms. Studies have also shown that mineralocorticoid receptor activity is critical to pathogenesis of CSCR, and a change to a glucocorticoid without significant mineralocorticoid action, such as dexamethasone can be considered in cases where steroids cannot be safely weaned.