Central serous chorioretinopathy (cscr) is a chorioretinal disease that most often affects middle-aged

men.characterized by posterior and focal serous detachments of the neurosensory retina and retinal
pigment epithelium alterations. The role of choroid hyperpermeability in the pathogenesis of CSCR has
been well documented recently with multimodal imaging modalities. In CSCR patients, a thick choroid has
been reported not only in the affected eye but also in the fellow eye, which is consistent with bilateral
choroidal hyperpermeability.
To date, several risk factors for CSCR have been identified, and the most consistent is corticosteroid
exposure from therapeutic administration or from endogenous overproduction, as in Cushing syndrome.
Corticosteroids were recently shown to induce choroidal vasodilation through mineralocorticoid receptor
activation in animal models. CSCR has also been associated with increased sympathetic activity and
sympathomimetic medication. Psychological stress and type A personality with narcissistic traits have
also been identified as contributing factors. Additional associations have been reported with hypertension, coronary heart disease, peptic ulcer disease, antihistamines, antibiotics, and
psychopharmacologic medications.
Shift work includes work hours that fall outside the standard daylight hours (7 AM to 6/7 PM),13
including evening, night, morning, rotating, and irregular shifts.
In industrialized countries, 15%20% of the work forc have regular shift work. It leads to circadian
misalignment and sleep disturbances that have been associated with increased risk of obesity, diabetes,
cardiovascular disease, depression, and cancer. Mechanisms underlying these health problems are not
fully elucidated but are thought to be related to sleep and circadian disruption. Indeed, sleep disturbances
have been associated with increased activities of the hypothalamic-pituitary adrenal axis and the
autonomic sympathoadrenal system, characterized by altered secretion of cortisol and catecholamine
hormones.
Since CSCR patients have higher levels of urine and plasma cortisol compared with the control group and
increased levels of plasma catecholamines, lead questione whether shift work and/or sleep disturbance
evaluated by the Insomnia Severity Index (ISI) could be risk factors for central serous chorioretinopathy.
This is a Prospective case-control study with forty patients having active CSCR and 40 controls (ageand sex-matched) were prospectively recruited from the Ophthalmology Department of Hotel Dieu
Hospital, Paris, between November 2013 and December 2014. All patients were asked to complete a
questionnaire addressing previously described risk factors and working hours, as well as the Insomnia
Severity Index (ISI), a validated instrument for assessing sleep disturbances.
The mean age of the CSCR group was 44 9 years, whereas the mean age of the control group was 43
10 years. By use of multivariate analysis, shift work (odds ratio [OR] [95% confidence interval]: 5 [1.2
20.4]; P [ .02), steroid use (OR: 5.5 [1.126.2]; P [ .03), and recent psychological stress (OR: 15.3 [4.1
54.5]; P < .001) were found to be indepen-dently associated with CSCR.
A significant association was identified between shift work and CSCR. Shift work may be an independent
risk factor for CSCR patients, and further research should be undertaken to confirm these preliminary
results. Workday reconfiguration should be considered as part of the therapeutic scheme of patients with
chronic and/or recurrent CSCR. If confirmed, CSCR could be added to the long list of shift work
associated diseases.
Source : Am J Ophthalmol 2016;165:2328.