Central Serous Retinopathy:

1-Year Homeopathic Case Study

Published in Naturopathic Doctor: News & Review (NDNR)

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Introduction

Central serous chorioretinopathy (CSC) is a self-limiting disease that typically presents with unilateral blurred vision and metamorphopsia (image distortion). Other symptoms can include dyschromatopsia (color distortion), micropsia (objects appear smaller), and dimness of vision. While the etiopathogenesis is poorly understood, symptoms are the result of fluid accumulation under the macular portion of the retina. CSC is most common in men between the ages of 20 and 40, and risk factors are thought to be strongly associated with sympathetic overactivation secondary to sleep disturbances, psycho-emotional stress, and history of corticosteroid use. Prognosis for visual recovery without treatment is strongly favorable, as symptoms typically improve or resolve within 1-6 months. However,  20-30% of patients may experience recurring symptoms within 12 months of symptom resolution. Conventional therapies for CSC include argon laser and photodynamic therapy, both of which aim to resolve fluid accumulation. The role of homeopathic medicines in the treatment and prevention of CSC has yet to be explored. However, research suggests that homeopathic medicines may attenuate overactive stress responses, particularly, neuroendocrine pathways responsible for inflammatory reactions and desensitization of negative feedback mechanisms (e.g. HPA-axis dysfunction). This case study illustrates the role of homeopathic medicine in the overall management of CSC and stress-related ailments.

 

Case Study

A 32-year-old male was diagnosed with CSC one month prior to presenting for a telemedicine visit in September 2020.  His visual symptoms were confined to the left eye and included blurred vision, dim vision, micropsia, dyschromatopsia, and metamorphopsia. Concomitant symptoms included left-sided facial paresthesia described as persistent tingling of the mouth, lips, and gums; mild to moderate aching and pressure in the left “inner ear”; globus sensation; insomnia; unrefreshing sleep; and back pain. He was rather distressed at the first appointment, expressing a great deal of frustration and fear about his health.

Generally, his demeanor was kind, reserved, and polite. He had thin, brown hair and a phlegmatic temperament. It was difficult for him to communicate his feelings aside from anxiety and fear. In fact, he spontaneously expressed several of his fears at different points throughout the interview; namely his fear of cancer, fear of ill health (hypochondriasis), and fear of weight gain: “I guess I worry that my health will get worse and decline into something like cancer.” When I asked him why he was worried about his health, he responded “I feel like I’m losing control.” I also asked him why he decided to call me for help, and he stated firmly that “I want to be healthy, and I know I can still feel better.” He then admitted that he felt embarrassed about it.  

In the professional sphere, he worked for a digital marketing firm which was a major and ongoing source of stress. The company he worked for was pressuring him to go above and beyond in his work ethic, and they were also merging with another company. These two workplace demands were increasing his stress load and disturbing his work space. “At jobs these days, everyone expects that you want to move up and that you’re going to do all of this extra work. I don’t want to move up; I just want to do the job and go home. I’m tired of putting on the fake smile and pretending I care more than I do.” He was not particularly passionate about the type of work he was involved with, and did not feel he had yet figured out his life purpose. The general uncertainty around his career, purpose, and the stressful atmosphere of his workplace proved to weigh heavily on him.

He reported that his physical body felt generally weak and achy, but especially his back. This was contrasted with his love for bodybuilding. His revolving goal had been the same for many years, namely to “get bigger and stronger” by lifting heavy weights. He felt that his recovery periods after exercise were slow and that he was prone to injuries: “My back feels stiff and it feels like I strained it. It just takes a while for it to recover after workouts.” When I asked him why he liked lifting heavy weights, he said he wanted to feel strong and confident in his appearance, which demonstrates a compensation for low confidence and self-esteem. He diligently persisted in lifting heavy weights and trying to get bigger for at least four years without making any significant changes in the size of his body.

   

After a review of systems, he reported easy and profuse perspiration despite having an overall cool body temperature. His hands were also cold and clammy. His diet included salty, fatty foods and a strong preference for eggs which he ate most days for breakfast. He practiced intermittent fasting because he was afraid of weight gain. He was not a very thirsty patient, as he drank only a few cups of water every day.

I inquired into the nature of his dreams, and he recalled one major recurring dream of losing control of a car. He stated that the emotional content of his dreams was “mainly fearful,” although he couldn’t recall very many.

Discussion & Treatment

The chief prescribing indication in this case was the patient’s anxious fearfulness. As it relates to CSC, fear strongly invokes the stress response. While his primary motivation for initiating a visit was to address the CSC, underneath was a deep fear that he was losing control of his health. The depth of his fear was further revealed by the emotional content of his dreams. Often illuminating repressed emotions and magnifying suppressed emotions, dreams can be helpful in understanding a patient’s core psycho-emotional experience. The litany of neuromuscular complaints, left-sided symptoms, desire for eggs, slow recovery periods, and profuse perspiration were also important confirmatory symptoms. Ultimately, his fearful nature, desire to get bigger as compensation for low self-confidence, in addition to his presenting concerns all led me to prescribe calcarea carbonica (calc-carb.) 200C. 

Calc-carb. is prepared from calcium carbonate extracted from oyster shells. It is a characteristically slow and fearful remedy state, often principally involving the musculoskeletal system.  The majority of calcium is found in the bones of the body; however, calcium is also critically important for nerve signal transduction, which helps to explain why calc-carb. often involves neuromuscular complaints.   

The fearfulness of calc-carb. is compensated for by seeking out protection and stability, especially as it pertains to health and finances, which are both critical sources of stability in adulthood. Most often in calc. carb, fearfulness results in passivity, immobility, and lack of courage. The patient’s slowness, desire to get bigger, and high level of stress induced by his career dissatisfaction are an example of compensation to the underlying disturbance (fearfulness).  Similarly, without their hard, definitive, protective shells, oysters are defenseless. They are also slow organisms; in fact, they’re totally immobile after finding a place to attach to in adulthood. An oyster’s entire life depends upon the structure and function of its protective shell and attachment to its home. Thus, like the oyster that calc-carb. is prepared from, patients in need of this medicine live with fear that their source of stability is at risk, and if that happens, life would surely become scary and overwhelming. The vital reaction is therefore to assure that this does not happen, thus they are reliable and steady workers who don’t challenge the status quo, prefer the comfort of certainty, and seek to gradually build themselves up. 

 

Follow-up Appointments

One month after the first appointment, the patient stated the following: “I think my eye is starting to get better; the vision seems less distorted. I haven’t really been feeling anxiety. The fear of cancer hasn’t been weighing on my mind. I think I was reserved and sort of robotic with my emotions, but I’m having highs and lows now, and I feel happy overall. I have the energy to do more and my mood is much better. I’m sleeping better and waking up before my alarm. I’ve been able to make a lot of new changes and have embraced new hobbies like writing, reading, model assembly, and photography. I haven’t noticed any pain in my ear, and the globus is gone. My face still tingles but not as much. I stopped lifting heavy weighs because I realize I have been doing too much.”

Two months after the first appointment, he stated: “This is amazing! My eye is significantly better. The color distortion seems to be gone, and my vision doesn’t seem as far away as it was. The blurriness is less significant. There is slight distortion that remains, but not all the time. I started a fast, and I don’t think I would have had the willpower to do even this 24-hour fast a few weeks ago. My back hasn’t been aching much, and my recovery has been good.”

 

Three months after his first appointment, he reported a less intense relapse of his visual symptoms, facial paresthesia, and anxiety. He stated that he was “still feeling good overall,” sleeping well, and his energy was stable. I prescribed another dose of calc-carb. 200C.

Six months after the first appointment, he reported that his eye was still slightly blurry, but not every day. He observed that both the facial paresthesia and visual symptoms worsened under stress. He stated that he was generally feeling “happy and content,” denied back pain, and interestingly, noted that he had been dreaming much more often. He stated that he was ready to find another career and realized how unhappy his job was making him.

Twelve months after the first appointment, he reported that he quit his job one month prior and figured out what he wanted to do with his life. “I’ve never been happier work wise—I’m building up a new portfolio and learning new skills. I realized how exhausted and stressed my job was making me feel. I am still sleeping through the night and waking up before my alarm feeling refreshed. But I still have some lingering symptoms—mild left wrist pain, mild inner ear ache, occasional globus, and facial paresthesia once in a while.” He reported blurriness of vision about five months prior, which he attributed to an extremely stressful period at his job. He also saw a specialist at that time for worsened ear pain, and the doctor stated that it was stress-related.  

I asked him what his biggest challenge was at the moment, and he said “building enough confidence to do what I’m doing now—I’m not as confident as I need to be, and it’s scary. I’m stressed and worried that my new career choice won’t work out.” I believe his lack of confidence was the primary reason for initiating the visit, because he didn’t speak much about his physical symptoms. He spent most of the time talking about his career change. I prescribed calc-carb 1M because I felt he required a deeper acting and longer lasting potency to carry him through his career transition over the next few months and to support his confidence level.

Case Synopsis

The patient’s stress levels were clearly contributing to his visual symptoms and overall symptom picture. It seems that calc-carb. attenuated his fear response, relieved psycho-emotional stress, and probably regulated the HPA-axis. In turn, his sleep improved and neuromuscular stress was relieved, which helped eliminate two of the major contributors to CSC. It is always refreshing when a patient reports new revelations and insights about the nature of meaningful life topics, i.e. career, and indicates a favorable response to the prescribed homeopathic. It will be interesting to see how he responds to the 1M potency over the next few months. Generally, this case study demonstrates the potential for dramatic improvements and improved stress-management following the use of well-indicated homeopathic medicines.

References

1. Bakri SJ, Berrocal A, Capone A, et al. Central Serous Chorioretinopathy. The American Society of Retina Specialists. https://www.asrs.org/patients/retinal-diseases/21/central-serous-chorioretinopathy. Published 2016. Accessed September 16, 2021.

2. Porter D, Gregori NZ. Central Serous Chorioretinopathy. American Academy of Ophthalmology. https://www.aao.org/eye-health/diseases/central-serous-retinopathy-treatment. Published 2019. Accessed September 16, 2021.

3. Semeraro F, Morescalchi F, Russo A, et al. Central Serous Chorioretinopathy: Pathogenesis and Management. Clin Ophthalmol. 2019;13:2341-2352. Published 2019 Dec 2. doi:10.2147/OPTH.S220845

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5. Whitmont EC, Perera SB. In: Dreams: A Portal to the Source. New York, NY: Routledge; 1989:5-7.

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7. Whitmont EC. Calcarea and Magnesia: A Comparison. In: Psyche and Substance: Essays on Homeopathy in the Light of Jungian Psychology. Berkeley, CA: North Atlantic Books; 1991:142-143.