7/21/2019 Central Serous Chorioretinopathy and Homoeopathy http://slidepdf.com/reader/full/central-serous-chorioretinopathy-and-homoeopathy 1/14 CENTRAL SEROUS CHORIORETINOPATHY (CSR) AND HOMOEOPATHY DR. RAJNEESH KUMAR SHARMA MD (HOMOEOPATHY) DR. SWATI VISHNOI BHMS
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7/21/2019 Central Serous Chorioretinopathy and Homoeopathy
SynonymsCentra Serous Chorio+retinopathy$ Centra Serous retinopathy$ CSC$ CSCR
De7nitiont is characteri8e% y a usuay se9+imitin6$ spontaneous serous %etachment o9 neurosensory retina in the macuar re6ion$ with or without retina pi6mentepitheium %etachment with retina ee:ation ea%in6 to hypermetropia. (*sora;Syphiis; Sycosis)
History o9 the %isease -322 + Von <rae9e+7rst %escrie% the %isease as recurrent serous
retinitis. -1-2 + =uch wor>e% appreciay on this %isease.
-1," + Horni>er ? name% %isease as @Centra n6iospasticRetinitisA.
-1/ + ash & Soane + @%iopathic at %etachment o9 macuaA. -1/ + <ior% an% MarEuar%t + Fheory on n6ioneurotic
6et typicay aects maes etween ,/ to 0/ years o9 a6e especiay personaitytype $ who are ri6i%y or6ani8e%$ hi6h status$ conscious$ sensiti:e$ truth9u$impatient an% aways tryin6 to hep others. (*sora; *seu%opsora)
SeGMae to 9emae ratio is 3- to -/-.
Causes Fhe actua cause o9 centra serous retinopathy is not we un%erstoo%. Stress an%seepessness may e the main causes (*sora). 4Gposure to any steroi%me%ication (nasa spray$ cortisone cream$ joint injection$ etc.) ha:e aso eenassociate%. (Causa occasionais)
Central Serous Chorioretinopathy (CSR) and Homoeopathy
*re6nancy (Causa occasionais) Ioca or systemic steroi%s (Causa occasionais) Hypertension (*sora; Sycosis) 4motiona stress (*sora; Causa occasionais) *ersons who are type personaity+ Sensiti:e$ truth9u$ impatient$ aways
tryin6 to hep others (*sora; *seu%opsora) er6ic respiratory %isease (*sora; *seu%opsora)
*atho6enesis Fhe source o9 su+retina ui% is the choroi%$ where a 9oca %e9ect in the retinapi6ment epitheium (R*4) aows serous ui% to accumuate un%er theretina resutin6 in a ocai8e% separation o9 the retina 9rom the retina pi6mentepitheium (*sora; Syphiis; Sycosis).
Fhere are two theories+
R*4 %ys9unction theory Fhe intact retina pi6ment epitheium creates a arrier etween the
neurosensory retina an% choroi%. (*sora) n areas o9 chorioretina scar tissue$ occurin6 a9ter inammation or
photocoa6uation$ the pi6ment epitheia %iusion arrier is permanenty%estroye%. (Sycosis; Syphiis)
Choroi%a capiaries eGert suction on the surroun%in6 ui%. (*sora) Fhe intact R*4 asors ui% in a retinochoroi%a %irection. (*sora) 'n%er certain con%itions$ the 9unction o9 the R*4 is re:erse% an% it
secretes in a chorioretina %irection. (*sora)
Choroi% %ys9unction theory *sycho6eny$ pre6nancy$ transpantation$ personaity type $ raise% cortiso
e:es causes a %isturance in the auto re6uation o9 choriocapiariesoo% ow. (*sora; Causa occasionais)
Circuatory %isturance in the micro circuation o9 the choriocapiariesea%s to increase ui% ea>a6e in the su+R*4 space. (*sora; Sycosis)
n the e6innin6$ the R*4 ces are ae to maintain their inte6rity an%9unction an% pump in a retina+choroi% %irection an% >eep the su+R*4space %ry.
Fhe proon6e% eGcessi:e stress on the R*4 ces utimatey causes a6enerai8e% %ama6e to the ces themse:es an% aso oss o9 9unction.(Syphiis; Causa occasinais)
Fhe oss o9 9unction o9 the conti6uous R*4 ces aows the ui% toaccumuate in the su+retina spaces cause a serous+retina %etachment orneurosensory %etachment. (*sora; Sycosis; Syphiis)
CSR presents with ui% spontaneousy ea>in6 into the su+retina space 9rom thechoroi% (*sora). Fhe retina ies on top o9 the choroi%$ a ar6e ayer o9 tissuepac>e% with oo% :esses an% capiaries. Fhe choroi% is 9unctionay separate%9rom the retina y a memrane cae% BruchJs Memrane an% a sin6e ayer o9 ces cae% the retina pi6ment epitheium (R*4). Fhis ayer wor>s i>e a arrierai%in6 nutrients to ow into the retina 9rom the un%eryin6 :esses. t aso aowsretina wastes to ea:e 9or remo:a y the choroi%a :esses. Fhe R*4 ayerpre:ents 9ree ow o9 ui%. n CSR$ this sea rea>s %own$ an% ui% ea>s into thesu+retina space (*sora; Syphiis; Causa occasionais). Fhis can occur in oth
eyes ut usuay presents in one at a time. 9ter a 9ew months$ the con%ition mayreso:e on its own. Fhere is up to a 0/ chance o9 ha:in6 a recurrent episo%e in
Central Serous Chorioretinopathy (CSR) and Homoeopathy
either eye. Recurrent episo%es in the same ocation or a persistent ea> in asin6e ocation can cause permanent %ama6e to :ision (Syphiis). Fhe rare utserious compication happens i9 scar tissue an% oo% :esses 9rom the choroi%occupy the space un%er the retina (Sycosis). Fhis tissue$ i9 not stoppe%$ cancontinue to 6row an% %estroy the centra retina or macua (*sora; Syphiis;
Sycosis). Fhis occurs more commony in o%er patients with recurrences.
SymptomsSymptoms are usuay uniatera+
Burrin6$ %istortion$ mini7cation o9 ojects an% a %ar> patch at 7Gation(*sora; Syphiis)
cute*atients are asymptomatic as there is no rea> in %iusion arrier.
Su+acutes the acute sta6e o9 the %isease pro6resses some patients %e:eop 9oca rea>sin the ti6ht junction o9 the R*4 ces. (*sora; Sycosis)
Chronic Fhe ea>in6 throu6h the rea> o9 ti6ht junction ecomes chronic a 7e% %e9ectwi %e:eop which o9ten in:o:es 9o:ea resutin6 mar>e% %ecrease in :isuaacuity. (*sora; Syphiis)
nacti:eMost o9 the patients in this sta6e ha:e no history o9 pre:ious eye proem. Fheyha% asymptomatic sta6e an% spontaneousy impro:e.
Iate compicationsSu+retina neo+:ascuari8ation %e:eops which is seen 0 to -/ years a9ter the7rst %ia6nosis o9 CSR. Su+retina neo+:ascuari8ation are o9 two types onuorescein an6io6raphy+
Fypica (one or two ea>in6 areas are seen on == (=un%us uoresceinan6io6raphy).
typica (Mutipe ea>s are seen on ==).
Dia6nosisDistance & !ear Visua cuity testin6Visua acuity can measure 2;2/ to 2;2. 2;2 is -// :isua acuity.
*roce%ure o9 %istance :isua acuity testin6 Distance :isua acuity chart is >ept at 2 meter. Ie9t eye is co:ere%. *atient is as>e% to rea% the chart 9rom top to ottom. 'p to which smaest
ine patient can rea% that is his :isua acuity in that eye. !orma %istance:isua acuity is 2;2 or ,/;,/.
Central Serous Chorioretinopathy (CSR) and Homoeopathy
Fhe test 9or other eye is repeate%.
*roce%ure o9 near :isua acuity testin6 Fhe near :ision chart is ho% at cm. Ie9t eye is co:ere%. Fhen patient is as>e% to rea% which smaest ine he can rea% that is the
near :isua acuity in his that eye. !orma near :isua acuity is !2. Fhe test 9or other eye is repeate%.
n CSR in:o:e% eye %istance :isua acuity re%uces 2;-3 to 2;1 an% o9tencorrectae to 2;2 with the a%%ition o9 a pus or con:eG ens. Some %isparity isaways seen etween the sujecti:e an% ojecti:e re9raction o9 the eye. But near:ision may not impro:e to !2$ i9 impro:es to !2 with stron6est pus ens thenaso patient is not ecome satis9y$ i9 he compares the :ision with other eye. Butthis acuity 9reEuenty chan6es with time.
Retinoscopyt is an ojecti:e metho% to %etermine the re9racti:e error o9 the eye.
*roce%ure o9 Retinoscopy Fhis test is per9orme% in a %ar> room. *atient shou% 7Gate on a %istant non accommo%ati:e tar6et that is 2;2/
or ,/;,// etter. Nser:er per9orms retinoscopy at a 7Ge% %istance that is - meter. n CSR
in:o:e% eye retinoscopic eGamination re:eas hypermetropia up to O- D%ue to swein6 in the centra retina as CSR shortens the :isua aGis.
mser <ri%*roce%ures o9 mser <ri% testin6 Fhe mser chart is ho% at cm away 9rom the eye with patient wearin6
rea%in6 6asses. Fhe e9t eye is co:ere% to per9orm the test 9or the ri6ht eye. *atient is as>e% to oo> at the centra %ot o9 the chart at a the time. *atient is instructe% to %raw on the chart i9 he notices any missin6 an%
%istorte% areas. n CSR cases centra :ision ecome urre% %ue to ui% accumuation in
the Macua. So in mser <ri% testin6 we 6et centra scotoma (non+seein6area) aon6 with %istorte% ine or wa:y ine.
Fhe proce%ure is repeate% 9or e9t eye.
*hotostress Reco:ery testin6*hotostress reco:ery testin6 is aso re9erre% to as %a88in6 time an% re+
a%aptation time. t is the perio% reEuire% 9or the macua to return to a normae:e o9 9unction a9ter ein6 eGpose% to an intense i6ht source.
Cinica proce%ure 9or photostress reco:ery testin6 =irsty$ the est correcte% :isua acuity 9or each eye is %etermine%. Ie9t eye o9 the patient is occu%e%. *atient is as>e% to 7Gate with ri6ht eye on the centre o9 the i6ht source
(Nphthamoscope or Forch i6ht) whie it is positione% approGimatey ,.0cm (Some practitioner maintain -/ cm) 9rom the eye.
Fhe %uration o9 :iewin6 is -/ to / secon%s. Remo:e the i6ht source an% imme%iatey patient is as>e% to rea% the ine
ao:e est correcte% :isua acuity. 9 *atients pre+test :isua acuity is 2;1then patient is as>e% to rea% 2;-, ine.
Central Serous Chorioretinopathy (CSR) and Homoeopathy
Fhe time (in secon%s) reEuire% 9or the patient to rea% at east one+ha9 o9 the ine is measure%. 9 the ine has 7:e etters then patient shou% rea% ateast etters. Fhe time ta>es 9or the norma eye is / secon%s or ess. Butin CSR patient the time ta>es more than the norma.
Fhe proce%ure 9or e9t eye is repeate% an% the resut is compare%. Fhe
%ierence etween norma eyes a:era6e 0 to 2 secon%s. But in CSRpatient the %ierence increases.
Nphthamoscopy Fhe 9oowin6 points are noteworthy+
4e:ation o9 Macuar area. circuar rin6+reeG on the retina. roun% or o:oi% ister i>e sensory retina %etachment o9 :arious si8es. =o:ea reeG asent or %istorte%. 9ter a 9ew wee>s o9 onset o9 the %isease$ tiny irre6uar white or yeow
precipitates ecome %eposite% on the retina. trophic R*4 chan6es as e:i%ence o9 pre:ious episo%es. n chronic cases$ a 7ne rown an% white pi6ment epitheia scar is seen. 4Gtra Macuar R*4 tracts.
Specia n:esti6ations=un%us =uorescein n6io6raphy (==)=uorescein %ye is injecte% in intra:enous an% simutaneousy seria photos o9 theretina with a 9un%us camera are ta>en. n CSR$ the %e9ecti:e area is so sma (inthe e:e o9 R*4)$ ony a tiny ea>a6e point is :isie %urin6 the eariest phase o9 ==. SuseEuenty$ there is rapi% increase in uorescein staine% iEui% in the su+retina ister %urin6 the 9oowin6 sta6es o9 an6io6raphy.
n%o+Cyanine+<reen n6io6raphy (C<)9ter the C< is injecte% intra:enousy$ the %ye is seen within the choroi%a:esses. ithin a 9ew minutes$ hyper+uorescent patches appear within thechoroi%.
Nptica Coherence Fomo6raphy (NCF)NCF is an eGceent non+in:asi:e %ia6nostic test which ceary %emonstrates theserous %etachment$ especiay when the serous %etachment is shaow.
*ro6nosis out 3/ o9 patients with CSR$ Spontaneous resoution o9 su+retinaui% an% :isua acuity impro:es to 2;1 or etter within # months.
Fhe remainin6 ,/ ast on6er than 2 months$ ut reso:e within -,months.
4:en i9 :isua acuity returns to norma$ some %e6ree o9 sujecti:e :isuaimpairment such as micropsia can persist.
Recurrences o9 the %isease may occur / to 0/ o9 patients. n chronic CSR$ pro6ressi:e R*4 chan6es associate% with a permanent
Central Serous Chorioretinopathy (CSR) and Homoeopathy
Freatment
Nser:ationNser:ation is o9ten use% in the 7rst month or two to see whether centra serousretinopathy mi6ht cear on its own. Routine eGercise an% 3 hours per %ay seep
seems to hep.
*hoto%ynamic therapy (*DF)t is sti eGperimenta.
*hoto%ynamic Fherapy (Visu%yne) Fhis treatment seems to e Euite eecti:e in some cases o9 centra serousretinopathy an% %oes not ea:e the same scarrin6 that aser can.
Iaser photocoa6uationIaser photocoa6uation can e %one at the point where ea>a6e seen on
uorescein an6io6raphy.
Iaser FreatmentIaser treatment 9or centra serous retinopathy has een one o9 the mainstays o9 acti:e therapy. Fhe i%ea is that with a si6ht amount o9 therma aser stimuation$the R*4 ces may scar$ an% the ui% ea> stop.
Cory8a$ hay+9e:er$ phthisis pumonais$ aso 6onorrhoea ha:e een inuence%9a:oray y this %ru6. *yeonephritis. rritation o9 the periphery o9 the urinaryapparatus. hoopin6+cou6h.
Hea%.+Iyin6 as i9 stupe7e% y a narcotic. Restess. =ace pae yeowish hue.
4yes.+Mar>e% aLnity 9or the eye. t pro%uces %etachment o9 the retina papio+retina in7tration %eposits in patches upon the retina amyopia an%
Respiratory.+Snee8in6 eyes iname% pain9u hea% hot. Hay+9e:er. Spasmo%icasthma etter in open air. Soreness in chest an% stomach must oosen cothin6.Dyspnoea an% si6hin6 inspiration. 4mphysema in the a6e% with asthma.hoopin6+cou6h$ on6 an% continue% paroGysms o9 cou6hin6$ unae to 6et arespiration. cute aryn6o+tracheitis. Bronchitis when the spasmo%ic eement isassociate% with tenacious
Nther Homoeopathic me%icines o9 repute in Retina %etachment
<esemium semper:irens
=RR!<FN! ? 4yes$ aections o9 ? *araysis o9 the eye+i%s an% occuar musces%ipopia$ %oue :ision$ ptosis eye+as osciatin6 ateray when usin6 themcannot te which si%e o9 the street he is on compete in%ness comin6 onsu%%eny.
Fherap.$ p.32 ri%o+choroi%itis (, cases)$ see !ortonAs Npth.
aoran%iCIRK4 ? Characteristics ? San%eser6 (B. . H.$ G. ,/-) notice% that the internause o9 aoran%i an% *iocarpin in cases o9 %etachment o9 retina an% choroi%itis
seeme% to occasion opacity o9 the crystaine ens. He treate% a horse 9or iri%o+choroi%itis an% ar6e opacities o9 the :itreous with in9usion o9 a. ea:es an%injections o9 *io..
sthenopia. sti6matism (). Nn usin6 eyes$ sensation o9 :ioent heat in them.
urum metaicum
H4R!< ? Si6ht an% 4yes ? Centra portion o9 retina :esses stron6y pusatin6.Chorio+retinitis chronica$ with an accumuation o9 ui% eneath retina$ whichsette% to ower portion o9 e9t eye$ causin6 a ar6e %etachment o9 retina.Hemiopia. Iar6e ac> suchoroi%a tumor ehin% ens in 9un%us$ 6rowin6 9rominner si%e. *upis not :ery acti:e 6eneray contracte%.
Fhere is mar>e% impro:ement in a the patients with retina %etachment as weas macuar hoes an% %e6eneration. can now say homoeopathy is as 6oo% inthis %isor%er as sur6ery %oes up to 1/.
Biio6raphy
4ncycope%ia Homoeopathica
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Central Serous Chorioretinopathy (CSR) and Homoeopathy
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