Central Serous Retinopathy

What is Central Serous Retinopathy (CSR)?

Central Serous Retinopathy is an eye disorder where fluid collects in the choroid (the layer between the retina and the outer wall of the eye).

The disorder can cause fluid leaks under the retina. The retina is the light-sensitive tissue lining the back of the eye. A functional deficiency under the central retina (Retinal Pigment Epithelium – RPE) results in blurry vision.

Central Serous Retinopathy (CSR) is also sometimes known as Central serous chorioretinopathy (CSCR).

Who is at Risk of Central Serous Retinopathy?

This disorder usually occurs more in men, between 30 - 50 years of age, and is more commonly seen in patients with cardiovascular issues such as high blood pressure (hypertension), people who use steroids and type-A personalities. 

How Does Central Serous Retinopathy Occur?

The pathophysiology of CSR is not fully understood yet. 

One explanation suggests that inappropriate activation of the mineralocorticoid results in elevated levels of testosterone and cortisol, which are responsible for choroidal circulation.

This would result in dilation of choroid vasculature and resulting in fluid exodus, or pooling under the retina and ending in Central Serous Retinopathy. 

Causes Of Central Serous Retinopathy?

There are multiple risk factors and causes associated with CSCR. One of the major factors is stress as people who are under constant stress loads are more likely to develop CSCR.

Other causes include:

• Hypertension
• Type A personalities (they have higher levels of circulating androgens)
• H. Pylori infection
• Cushing syndrome
• External intake of steroids for medication or recreational use
• Alcohol use
• Auto-immune diseases

Symptoms of Central Serous Retinopathy

The presenting complaints of Central Serous Retinopathy include some or all of the following symptoms:

• Central vision is blurred or dimmed, with normal peripheral vision
• Central vision may have a dark line 
• White objects may appear to have a dull colour or exhibit a brownish hue (colour saturation loss, decreased contrast sensitivity)
• Certain objects may appear farther than they are or smaller in size (Micropsia)
• Loss of central vision
• Positive scotoma 

Types Of Central Serous Retinopathy

There are no subtypes of CSR.

Stages Of Central Serous Retinopathy

There are no stages, but the severity is gradient and depends on how progressed the disorder is. Loss of central vision and deterioration in quality is directly proportional to the amount of collected fluid. 

How is Central Serous Retinopathy Diagnosed?

Your ophthalmologist will make a diagnosis of CSR based on a

• Comprehensive patient history 
• Detailed ocular Eye Examination. 
• Optical Coherence Tomography (OCT) of the retina
• Fluorescein Angiography. 

Further examination to determine the degree of vision loss is done as well.

How is Central Serous Retinopathy Treated?

CSCR is often approached on a conservative basis as many cases of Central Serous Retinopathy resolve on their own as the fluid drains away after a couple of weeks. 

Your ophthalmologist will do follow-ups to keep an eye on the progress of resolution and if vision loss is severe or there is a risk of Retinal Detachment due to the excessive fluid buildup alternative treatments would be considered. 

In these cases, the ophthalmologist may opt for either:

• Photodynamic Treatment or
• Laser Surgery. 

They restore vision by sealing the choroid leak.

What If Central Serous Retinopathy Is Untreated

If left untreated, many patients with CSR recover on their own and have good vision. 

If the CSR is recurrent requires follow-up visits or causes other complications that go untreated, patients can face a high risk of permanent loss of vision due to chronic fluid accumulation.