EpistemisMicropsia and Macropsia
Specialty: Ophthalmology.
Why it occurs
- Central serous chorioretinopathy (physically separates the macular photoreceptors, causing micropsia)
- Epiretinal membrane with active traction on the fovea (can cause macropsia due to crowding of photoreceptors or micropsia due to stretching)
- Clinically significant diabetic macular edema
- Posterior vitreous detachment with incomplete foveal traction
- Migraine with atypical visual aura (Alice in Wonderland Syndrome)
- Tumor or vascular lesions of the temporal-occipital lobe
Initial workup
High-definition macular Optical Coherence Tomography (OCT) (to objectify the foveal microarchitecture and document the presence of vitreo-macular traction or pigment epithelium detachment); Fluorescein angiography (FGA) if choroidal leak points are suspected; Three-dimensional Amsler grid; Brain MRI if a non-ocular central origin is suspected with a completely unremarkable fundus examination.
red flags
Sudden distortion in the apparent size of objects associated with sudden loss of central visual acuity or visualization of a gray spot in the axis of gaze, suggestive of an acute retinal exudative phase or severe foveal traction.
Standard management
- Eplerenone — 50 mg orally daily, mineralocorticoid receptor antagonist, used in specific protocols for chronic central serous chorioretinopathy to reduce subretinal fluid, under strict control of plasma potassium
- Intravitreal anti-VEGF injections — p. e.g., Ranibizumab 0.5 mg or Aflibercept 2 mg if dysmetropsia is associated with active choroidal neovascularization or inflammatory macular edema
- Artificial tears (as symptomatic lubrication, with no effect on the underlying foveal pathology).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Ophthalmology
- Listed causes
- 6
- Treatment options
- 3