Central Serous Retinopathy

Wednesday, Jul 1, 2020 by Nisha Gupta, MD

This month’s topic will be a condition called central serous retinopathy (CSR).

What is central serous retinopathy?

Central serous retinopathy is a condition that involves the choroid and retina. Fluid collects in the back of the eye in the macula. This area controls the central vision. The fluid comes from the choroid, which is underneath the retina. When the fluid builds up, it causes a small separation or detachment of the retinal layers. This causes changes in the vision.

What are the causes and risk factors for developing CSR?

The causes of CSR are not fully understood. Research has shown that it tends to occur in people with type A personalities. Steroid use also plays a role. This may be in the form of pills, injections, or creams. It also includes steroids that are naturally in the body and may increase in times of stress.

Men tend to be more affected by this than women. Other risks include taking external testosterone and certain medications like decongestants.

There is some research that those with high blood pressure, heart disease, and those with a recent or current pregnancy are also at higher risk.1

What are the symptoms?

Patients usually feel blurry central vision with CSR. One can have trouble with fine details and have distorted vision. Usually this affects one eye, but it can also affect both eyes.

Central serous retinopathy can cause permanent vision changes or loss if the fluid remains in the eye without treatment. It can also recur throughout a person’s lifetime.

How is CSR diagnosed?

A comprehensive exam including checking the vision and dilating the eyes is needed to diagnose CSR and assess its effect on the vision. The dilated exam allows doctors to look at the macula and determine how much fluid has collected. In chronic stages, doctors look for scar tissue.

An optical coherence tomography (OCT) photo is taken to look at the layers of the retina to see the fluid collection.

Central serous retinopathy

Photo of central serous retinopathy. Image Source2

The arrow in this photo shows the fluid that has collected in between the layers of the retina.

A fluorescein angiogram is occasionally done to confirm this diagnosis. This test involves injecting a dye into a vein in the arm and taking photos as the dye courses through the blood vessels in the eyes.

How is this treated?

Most often this condition resolves on its own without treatment and vision goes back to normal in a few weeks to a few months. Most doctors will wait a few months to see if the fluid resolves.

If it is safe to do so, patients should discontinue the use of any steroids and be very cautious if the need arises in the future. CSR can recur with the use of steroids later in life.

There are two lasers that have been used to treat CSR. One is called photodynamic therapy in which a substance called verteporfin is injected into the arm. It is activated by the laser and can treat some chronic cases of CSR. There are ongoing studies involving micropulse laser that does not cause as much damage to the retina.

Finally, there are some cases that have been treated with an oral medication known as mineralocorticoids. However, their use has not been widely tested and they do not work in all cases.

Ultimately, it is important to have frequent follow up visits to monitor the eyes for any changes and determine the need for any treatment.

Return next month for a new topic!

  1. American Society of Retina Specialists. 2020. Central serous chorioretinopathy. Direct link [return]
  2. Image courtesy of Nisha Gupta, MD [return]

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