Central serous retinopathy: Symptoms, causes and treatment

What is central serous chorioretinopathy (CSCR)?

Central serous chorioretinopathy is the result of fluid buildup under the retina. This build-up can cause the retina to detach at the macula. This results in distorted, blurry central vision in one or both eyes. Corticosteroid use, stress, middle age and being male increase your risk of developing CSCR.

This condition is one of the top 10 most frequently seen conditions affecting the back of the eye. It is a fairly common cause of mild or moderate vision loss. 

What causes central serous chorioretinopathy?

CSCR is also known as central serous retinopathy or choroidopathy. Doctors are not certain why it occurs in individuals with otherwise healthy eyes.

Central serous retinopathy is caused by fluid build-up under the retina. This fluid is leaked from the choroid, a layer of blood vessels that lies under the retina. In between the retina and choroid is another layer of cells. This layer is called the retinal pigment epithelium. It serves as a barrier that prevents fluids from the choroid from leaking into the retina. 

If this barrier breaks down, a small area of leaked fluid from the choroid can pool under a part of the retina called the macula. This is the area of the retina that provides clear, central vision. When this happens, vision becomes distorted and blurry. 

Who is at risk for central serous chorioretinopathy?

Central serous chorioretinopathy is typically seen in people who are in their 30s and 40s. There are certain risk factors that are associated with developing the condition. These include:

• Being male 

• Being middle-aged

• Using corticosteroid injections, nasal sprays, asthma inhalers and corticosteroid creams

• Having high blood pressure

• Being highly stressed

• Having a type A personality

• Having insomnia

• Having an H. pylori infection

• Having an autoimmune disease

CSCR is six times more common in men than women. In fact, it is one of the most common causes of decreased vision in middle-aged men.

Individuals experiencing stressful episodes are at higher risk of developing this condition. People with type A personalities (competitive, ambitious, impatient) are also at increased risk.

What are the symptoms of central serous chorioretinopathy?

The most common symptom of CSCR is blurry, distorted vision. This can occur suddenly or gradually as the fluid builds up under the macula and causes it to detach. This condition is typically seen in one eye, but may affect both eyes. 

The symptoms of central serous retinopathy include:

• Central vision that is blurry, dim, distorted or has a dark area

• The appearance of straight lines as irregular or wavy

• The appearance of objects as more distant and smaller than they actually are

• Color vision distortion resulting in a dull, brownish hue to white objects

If you notice vision symptoms such as blurry, distorted or darkened vision, contact an eye doctor for evaluation.

It is important to note that if fluid buildup under the retina is not near the macula, an individual may not experience any symptoms.

How is central serous chorioretinopathy diagnosed?

Central serous chorioretinopathy is diagnosed by an eye doctor. The doctor will need to perform a dilated eye exam to look at the retina. Specialized tests may also be needed to detect areas of the retina that CSCR has affected:

• OCT angiography – a procedure that provides high-quality 3D images of cross-sections of the retina. It is painless and does not require an injection. OCT allows doctors to see where fluid has built up under the retina.

• Fluorescein angiography – a procedure in which dye is injected into the arm and travels to the eye. It provides doctors with retinal images that allow a clearer view of where the leaking blood vessels in the retina are located.

What is the treatment for central serous chorioretinopathy?

CSCR usually resolves by itself in about 60% of cases. Due to this, doctors typically do not treat the condition right away. They may discontinue any medication with corticosteroids. They may also recommend decreasing stress and developing a healthy lifestyle. This includes routine sleep, decreasing stress, good nutrition and daily exercise. 

In most cases, the fluid under the retina will gradually go away by itself, and vision will likely return to normal. The recovery time from central serous chorioretinopathy can be several weeks to a few months. 

If fluid under the retina is still present after several months, an eye doctor may prescribe oral medications. They may also suggest over-the-counter therapies such as melatonin. Melatonin helps to regulate sleep and has been found to be beneficial for eye health. 

In some patients, surgical treatment may be necessary:

• Laser photocoagulation – This laser treatment helps to reduce fluid under the retina. The laser forms scars in the retinal pigmented epithelium, which decreases fluid leakage. 

• Photodynamic therapy – This treatment uses a laser and an injected drug that work in combination to decrease fluid leakage.

What is the prognosis for central serous chorioretinopathy?

CSCR often occurs only once. However, about 40-50% of people will have a recurrent episode in the same eye. In rarer cases, an individual can have chronic central serous retinopathy.

Vision impairment from CSCR is not usually permanent, but it can last four to six months. Most individuals return to their normal visual acuity without lasting visual distortion. In some cases, there may be a permanent, but mild, decrease in vision. 

Although it is unusual, long-term complications, such as the formation of abnormal blood vessels, can occur. Due to this, it is important to see an eye doctor for a comprehensive eye exam as soon as symptoms of central serous chorioretinopathy are noticed. 

Page published on Wednesday, June 8, 2022