Context:The preferential occurrence of idiopathic central serous chorioretinopathy (ICSC) in males with a typical Type A personality and behavior and a relative absence in females is a possible indicator towards the role of serum cortisol and /or the male sex hormone testosterone.Aims:To study levels of cortisol and testosterone in ICSC.Settings and Design:Case-control study in a tertiary care teaching hospital.Materials and Methods:The study was conducted on 23 cases of ICSC. Twelve patients with unilateral sudden painless loss of vision of less than one month duration served as controls. Serum cortisol and testosterone levels at 8.00 a.m. were estimated by radioimmunoassay in both groups.Statistical analysis used:Statistical analysis was done using SPSS 13.0 software. Independent Sample t-test was applied to analyze statistical significance between the two groups.Results:Mean age of patients with ICSC was 37.1 ± 9.7 years and 96% of the patients were males. Mean serum cortisol levels were significantly higher (P=0.002) in patients with ICSC i.e., 495.02 ± 169.47 nano moles/liter (nmol/L) as compared to controls i.e., 362.25 ± 51.54 nmol/L. Mean serum testosterone levels were 3.85 ± 1.81 nano grams/ml (ngm/ml) and 4.23 ± 1.89 ngm/ml in cases and controls respectively and the difference was not statistically significant (P=0.58).Conclusions:ICSC is associated with elevated 8.00 a.m. serum cortisol levels. However, mean serum testosterone levels in both patients of ICSC and controls were within normal range.

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Several classes of drugs,including sympathomimetics,anticholinergics, selective serotonin re-uptake inhibitors, tricyclic antidepressants and antihistaminics have been reported to induce or precipitate acute angle closure glaucoma, especially in predisposed individuals who have narrow angles of the anterior chamber [1]. Flavoxate, a tertiary-amine antimuscarinic, is used for its antispasmodic properties in the symptomatic treatment of many urological conditions including overactive bladder and incontinence. It increases urinary bladder capacity, possibly because of action on the detrusor muscle [2]. All anticholinergics present a risk of precipitating angle closure glaucoma [1]. However, there is no previous report of flavoxateinduced glaucoma. Here we report, for the first time, a case of bilateral acute angle closure glaucoma following flavoxate administration.A 50 year old female with chronic right sided pyelonephritis was receiving the following oral medications: ofloxacin 200 mg twice daily, indapamide 5 mg once daily and propranolol 20 mg once daily for the past 1 year. She consulted a nephrologist because of urge incontinence and was prescribed flavoxate (Urispas) 200 mg twice daily. Nine hours after ingesting a single tablet she presented in the Emergency Department of JN Medical College, Aligarh, India with complaints of sudden painful diminution of vision in both eyes (which started as blurring of vision) with severe frontal headache,redness of eyes,nausea,vomiting and palpitations. There was no history of similar episodes of painful diminution of vision in the past or a history of similar complaints in any of her first degree relatives. There was no history of allergy to any drug.On examination, her pulse rate was 93 beats min -1 , blood pressure was 132/90 mmHg, respiratory rate was 16 breaths min -1 and she was afebrile. Systemic examination revealed no apparent abnormality. Ocular examination revealed the following in both eyes: visual acuity of finger counting at 1 metre, projection of rays (a test for function of the peripheral retina) was accurate, circumciliary congestion, corneal oedema, shallow anterior chambers, normal iris pattern, mid-dilated, oval shaped non-reacting pupils and immature senile cataracts. The eyes were 'stony hard' on digital tonometry. On slit lamp examination, corneal epithelial and stromal oedema, shallow anterior chambers (Von Hericks grade one), mid dilated non reacting pupils and nuclear sclerosis grade 1 were noted. Schioetz tonometry showed a reading of 1/10 g i.e. 69.3 mmHg (normal range 10-21 mmHg) in both the eyes. Non contrast CT scan of the head revealed no abnormality.She was advised to stop the suspected drug, flavoxate. She was given 60 mg pentazocine intramuscularly, 1 ounce glycerol orally, 300 ml of 20% mannitol intravenously, 500 mg acetazolamide orally stat and then 250 mg 6 hourly and 0.5% timolol topically 12 hourly.The intraocular pressure returned to normal levels (17.3 mmHg in both eyes) within 10 h of starting the above treatment. Gonioscopy show...