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I read with interest the article entitled “Central serous chorioretinopathy after dacryocystorhinostomy operation on the same side” by Mondal et al. However, I have a strong reservation to accept that the central serous chorioretinopathy (CSCR) in the said case was due to the action of xylometazoline nasal drop or stress related to dacryocystorhinostomy (DCR) operation. Let me explain in the following few lines:
Each and every external DCR operation performed on earth is associated with some amount of operative stress on the patient, and also associated with the routine preoperative and postoperative use of nasal decongestant drops like xylometazoline/oxymetazoline. There was nothing in the article to suggest extraordinary stress like prolonged operative time, excessive bleeding or patient factors like highly stung (Type A) personality, nor there was anything to suggest prolonged use or excessive systemic absorption of the drug. In contrast, the drug was used for only 1 day (first postoperative day) before the symptoms of CSCR appeared on the second postoperative day.
Therefore the said case was one of the few millions of routine external DCR operations performed throughout the world for many years but without a single reported incidence of CSCR. A complication as startling as CSCR would have been reported, had it ever occurred in any part of this world (PubMed search, “Dacryocystorhynostomy and Central serous chorioretinopathy”–no results).
According to Karch et al. as referred to in the Laurence Book of Clinical Pharmacology (7th edition), the following criteria have to be fulfilled before attributing a cause-effect relationship between a drug and an adverse event:
However, none of the criteria have been fulfilled in the reported case:
Therefore, in my opinion the reported CSCR was mere a chance association rather than the side-effects of stress and xylometazoline nasal drop.