Bullous retinal detachment in a patient with central serous chorioretinopathy

Bullous retinal detachment, a severe and atypical presentation of central serous chorioretinopathy (CSCR), may develop in association with the use of systemic steroids. A 42-year-old man presented with a 2-month history of poor visual acuity in his right eye. A tentative diagnosis of Harada's syndrome was made and the patient was treated with large doses of systemic corticosteroids for 1 month, without improvement. Fundus examination showed bullous detachment with shifting subretinal fluid in both eyes. Fluorescein angiography demonstrated multiple leaking points with pigment epithelium detachment in both eyes. A diagnosis of bilateral severe CSCR was made and systemic steroid therapy was withdrawn. Several sessions of argon laser photocoagulation to the areas of fluorescein leakage in both eyes and transscleral drainage of subretinal fluid in the right eye were performed. Two months later, the retinae became attached in both eyes. Visual acuity in the right eye was limited by submacular fibrosis, while the visual acuity of the left eye was not affected. In summary, this case should alert physicians to suspect CSCR in patients with exudative retinal detachment, as the use of steroids is usually not only unnecessary but can also be harmful.