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A 39-year-old obese woman presented with bilateral blurred vision worsening over 2 days. She also complained of lower back pain for the previous 3 weeks. Her ocular history revealed no abnormalities. Her medical history was significant for HELLP (Haemolysis, Elevated Liver enzyme levels, Low Platelet count) syndrome 12 years ago during her first pregnancy. On examination, best-corrected visual acuity (BCVA) was 20/100 in the right and 20/400 in the left eye. Intraocular pressure, motility and anterior segments of both eyes were normal. Ophthalmoscopy revealed bilateral central serous retinal detachment and several cotton wool spots (figure 1). On general examination, blood pressure (BP) was 230/150 mmHg. Laboratory tests showed leucocytosis (19 700/µl), anaemia (3.77 Mio RBC/µl), thrombocytopenia (57 000/µl), elevated liver enzymes (GOT 58 U/I, GPT 52 U/I, alkaline phosphatase 170 U/I) and impaired renal function (creatinine 1.24 mg/dl). Figure 1 Fundus photography taken on the day of admission, composite image; (A) right eye, (B) left eye; both eyes showed a pronounced central serous retinal detachment on the day of admission. 1. How will you approach a patient presenting with secondary retinal detachment in both eyes of acute origin. What further investigations will you do? 2. How do you manage such a case? 3. Describe the spectral domain optical coherence tomography (OCT) findings (figure 2). Figure 2 Spectral domain optical coherence tomography (OCT), pictures on the left show infrared photography with selected scan, on the right corresponding scan. (A) Right eye: —top, OCT at first presentation; …