a 43-year - old man had sudden blurring of vision , metamorphopsia , and paracentral scotoma in his left eye on the second postoperative day of dacryocystorhinostomy operation on the same side .
ocular examination showed best - corrected visual acuity of 20/20 in the right eye and 20/80 in the left eye .
fundus fluorescein angiogram detected multiple leakage sites with smokestack pattern because of pooling of the dye under the neurosensory retinal detachment in the macula [ fig . 1 ] .
after one week of omission of the nasal drops , there was a gradual resolution of symptoms .
fundus photograph and fluorescein angiogram of the left eye showing few hyperfluorescent lesions within the foveal avascular zone and along the superior arcade , from the early venous phase , with evidence of profuse leakage along with pooling of dye during the late phase , indicative of cscr
central serous chorioretinopathy is a multifactorial disease , which took many years to reach the precise clinical definition because of controversial etiopathology .
it is usually associated with corticosteroid use , type a personality , organ transplantation , pregnancy , hypertension , and psychopharmacologic medication .
recently , we have also reported a case of bilateral cscr following one intraarticular injection of corticosteroid . in this patient or case , only a topical instillation of xylometazoline in nasal mucosa produced cscr .
it is documented that post - traumatic stress is associated with excessive release of catecholamines .
topical application of xylometazoline , an alpha adrenergic receptor agonist , through the nasal route can cause severe systemic side effects . even a single intranasal dose of xylometazoline has been shown to be associated with coma in a neonate and sudden death in a 13-year - old boy due to the rupture of an intracranial aneurysm . in an observational case series of cscr associated with the use of sympathomimetic agents , occurrence of one case of cscr followed the use of oxymetazoline nasal spray three to four times daily for one month . in our case ,
excessive systemic absorption of xylometazoline from the inflamed nasal mucosa may have enhanced the post - traumatic stress - induced adrenergic stimulation leading to an increase in the choroidal circulation and alteration of the pump action of the retinal pigment epithelium , events which are related to the development of cscr . on the contrary
, the intranasal instillation of a few drops of xylometazoline may have been a chance association with the occurrence of cscr , but one interesting point to refute this concept is the spontaneous quick resolution of visual symptoms after discontinuation of this topical medication .
this case report widens the spectrum of drugs whose use should be enquired into while examining a patient with cscr .
 a 43-year - old man developed central serous choroidoretinopathy in his left eye following dacryocystorhinostomy operation on the same side . 
 he was using xylometazoline nasal drops in his left nostril . 
 action of xylometazoline or the stress related to the operation or the effect of both factors played the role in the causation of this ocular condition . 
 omission of nasal drops or relief from stress resulted in full recovery of vision and complete resolution of symptoms within one month . 
Case Report
Discussion