central serous chorioretinopathy ( cscr ) is a chronic idiopathic condition affecting young to middle - aged patients with men affected more commonly than women .
it is characterized by serous detachment of the neurosensory retina , with focal or multifocal areas of leakage of the retinal pigment epithelium ( rpe ) affecting the macular area . the exact cause of cscr is not clearly understood .
nevertheless , it is associated with psychological stress and systemic corticosteroid therapy , which causes hyperpermeability of choriocapillaries , leading to dysfunctional degeneration of the rpe [ 1 , 2 ] .
a 23-year - old man presented with a sudden decrease of visual acuity of the right eye ( re ) 4 days after rhinoplasty for a deviation of the nasal septum .
general anesthesia was induced with propofol 2 - 5 mg / kg i.v . and sufentanil 0.5 g / kg i.v .
no corticosteroids , antibiotics or other postoperative treatment was used . at presentation , best - corrected visual acuity of the re was 6/9 with metamorphopsia .
fundus examination revealed a well - delineated serous elevation of the macula and fluorescein angiography ( fa ) showed a focal rpe leakage .
the optical coherence tomography ( oct ) sections through the macula depicted a mild neurosensory retinal detachment with an increase in retinal thickness equal to 245 m ( fig .
two weeks later , without any treatment , a gradual improvement of the symptoms was assessed .
one month after the operation , visual acuity of the re returned to 6/6 and the neurosensory retinal detachment disappeared .
also , fa revealed the disappearance of rpe leakage and the retinal thickness of the macula measured with oct was 183 m ( fig .
cscr is a multifactorial disease with controversial etiopathology and it is usually associated with steroid use , pregnancy and stress .
the exact mechanism by which glucocorticoids are involved in the development of cscr is still unknown .
it is possible that a constitutionally determined susceptibility of the posterior blood - retinal barrier must be present so that , under the effect of exogenous or endogenous glucocorticoids , cscr develops .
found elevated values of urinary free cortisol in patients suffering from cscr not exposed to exogenous glucocorticoids and without biological signs of endogenous cushing 's syndrome .
psychologic stress has been known to produce hypothalamic - pituitary - adrenal axis abnormalities like endogenous cortical excess , which has been found in some patients with cscr .
in fact , the use of imidazole derivatives like oxy- and xylometazoline , which directly stimulate alpha - receptors and are more alpha-2-selective , are associated with the manifestation of cscr [ 6 , 7 ] . in our case
, the use of xylometazoline may have enhanced the post - traumatic stress and induced adrenergic stimulation leading to an increase in the choroidal circulation and alteration of the pump action of the rpe , which is related with the development of the cscr .
however , the simultaneous increase in choroidal resistance has no effect on choroidal blood flow , which will be regulated to be maintained constant . in summary ,
we present a case of cscr after rhinoplasty , which to the best of our knowledge has not been previously reported .
this case shows a possible association between the postoperative stress or the use of xylometazoline and cscr and widens the spectrum of drugs associated with the occurrence of the disease .
 we report a case of central serous chorioretinopathy after rhinoplasty for deviation of the nasal septum in a 23-year - old caucasian man . 
 the patient complained of deterioration of vision in the right eye 4 days after rhinoplasty . at presentation , 
 visual acuity of the right eye was 6/9 with metamorphopsia . 
 fluorescein angiography revealed a focal retinal pigment epithelium leakage and optical coherence tomography an increase in macular thickness to 245 m . 
 the left eye was normal . 
 one month after the operation , without any treatment , visual acuity returned to 6/6 , the leakage of the retinal pigment epithelium disappeared and the macular thickness returned to 183 m . to the best of our knowledge , central serous chorioretinopathy after rhinoplasty has not been previously reported . 
 this case report shows a possible association between the postoperative stress and central serous chorioretinopathy . 
 moreover , it widens the spectrum of drugs associated with the occurrence of the disease . 