Central Serous Retinopathy

About Central Serous Retinopathy

Central Serous Retinopathy (CSR) or Central Serous Chorioretinopathy (CSCR) is a relatively common condition that usually affects the very center of the retina, an area called the macula. This tiny area is responsible for our central vision. The hallmark of CSR is an accumulation of fluid underneath the retina in the macula, which causes a decrease in visual sensitivity and even distortion of the vision. Commonly, patients describe the symptoms as looking similar to the round spot that one notices in the vision just after a camera flash. Middle-aged males are most commonly affected, but the condition can occur with any age and gender. Usually only one eye is symptomatic, however it is typical for evidence of the condition to be seen in both eyes after testing is performed.

The fluid accumulation that occurs in CSR originates from a layer of blood vessels located underneath the retina called the choroid. Typically, a few small areas of leakage are noted with specialized testing that confirms the diagnosis. The reason for this leakage is unknown, but is thought to be related to changes in the body’s production of natural steroids. Patients that have been under unusual stress are known to be more prone to the condition, which is explained by the body’s increased steroid production of steroids under stress. Additionally, prescription medications or supplements that contain steroids are known to cause CSR in susceptible individuals.

Treatment of Central Serous Retinopathy

The good news about CSR is that it usually will resolve on its own, usually within 2-3 months. Better than 90% of patients will improve to their previous level of vision, although some patients may still notice a persisting area of visual disturbance or reduced color sensitivity even if the leakage has resolved. Because almost all cases resolve on their own with treatment, no treatment is usually recommended for the first 1-3 months unless the leakage is unusually severe or if the symptoms are intolerable to the patient. If the leakage persists after this, treatment is indicated. Treatment is performed with one of several types of laser which is directed at the leaking areas of the choroid as identified with specialized testing. This is usually quite effective and the risks associated with treatment are low.

In a patient with a history of CSR, it is very important to avoid steroids or steroid-containing medications which might be prescribed by your doctor for unrelated issues unless absolutely necessary. These medications can cause a severe recurrence of leakage which can be difficult to control.

Prognosis

As discussed above, the prognosis is excellent for most patients since greater than 90% of cases resolve spontaneously with minimal vision loss. However, continued monitoring is necessary because over 40% of patients will develop a recurrence at some point in their life.

In a minority of patients (5-10%), the condition may become chronic, with continued or worsening leakage over time. In this group of patients, the prognosis is less favorable because the presence of fluid over many months or years eventually causes significant permanent damage to the retina and the underlying tissues. However, various types of laser treatment can also be very effective even in these chronic cases.