Central Serous Chorioretinopathy – Causes, Symptoms, and Treatment

The retina of the eye is a complex structure, composed of ten layers of different cell types that work together to sense light incoming from the external visual environment, convert it into a neural impulse, and send this signal onward to the visual processing centres of the brain for perception and interpretation. Disruption to any of these retinal layers, whether from disease or trauma, has the potential to affect our vision. In some cases we may not even be aware of changes to our vision while in others, such as during central serous chorioretinopathy (or CSCR), it can be quite obvious that something is not right. 

What is Central Serous Chorioretinopathy?

Also known as central serous retinopathy, central serous chorioretinopathy is a retinal condition characterised by the accumulation of serous fluid beneath the sensory retina, resulting in detachment from the underlying layers.

As the name suggests, this fluid accumulation tends to occur around the macula, which is responsible for our central vision. Because the macula is the most sensitive part of our vision that we use to discern fine detail such as text and colour, distortion to the retinal tissues in this area is often easily apparent, however, some people with central serous chorioretinopathy may be slow to become aware of any issue, particularly if the affected eye is the non-dominant one, or if the swelling happens to occur slightly further away from the macula where we’re less attentive to changes. 

The exact underlying causes of central serous chorioretinopathy are not fully understood but is thought to be a result of some sort of dysfunction of the blood vessels underlying the retina in the vascular choroid layer, or impairment of another supporting layer called the retinal pigment epithelium (RPE), which permits too much fluid to cross its cells. The ultimate result is leakage and accumulation of serous fluid from the blood vessels beneath the sensory retina, causing a swelling and distortion of the overlying tissues. 

Central serous chorioretinopathy is much more common in men than in women, about 6 times more frequent, and typically affects those between 20 and 45 years of age. 

Certain risk factors are associated with the development of central serous chorioretinopathy, including:

• Steroid medications, which can include steroid tablets, creams, injections, or even nasal sprays 
• Emotional and psychological stress
• Type A personalities (those who tend to be competitive, impatient, and anxious; possibly associated with high-stress behaviours)
• Pregnancy
• Sleep disturbances, such as sleep apnoea or insomnia
• Hypertension 

Because central serous chorioretinopathy involves a swelling of the retina, vision in that particular area of the eye is distorted. It may be difficult to describe the experience exactly, as not all people with the condition feel that the vision is necessarily “blurry”.

While some may report that their visual acuity is perceived to be decreased, they may also describe the sensation as:

• Feeling as if the vision is distorted, that straight lines appear wavy or bent
• A dark or dimmed patch in the vision
• Objects in the affected eye appearing smaller or further away than when viewing with the other side
• A disturbance to the colour vision in the affected eye, such as colours appearing unusually dull 

Treatment

Your eyecare practitioner, whether an experienced optometrist or ophthalmologist, is able to diagnose the presence of central serous chorioretinopathy by viewing your retina with various techniques, including:

• Fundoscopy (directly assessing the retina with a light and biomicroscope)
• Fluorescein angiography (involving intravenous injection of a fluorescent dye to view areas of fluid leakage in the retina)
• Optical coherence tomography (a non-invasive scan that allows visualisation of the outer layers of the retina)

Many cases of central serous chorioretinopathy will self-resolve over a few months without any intervention or need for retinal surgery. It helps to be able to identify and address any underlying factors, such as stress or the use of steroid medications. 

In select situations, you may be referred to an eye specialist familiar with retinal surgery and managing retinal conditions. Such cases include those that are taking too long to self-resolve, chronic cases, frequently recurrent cases, or for patients who suffer existing poor vision in the other eye or have some other reason for requiring a rapid recovery. 

Certain patients may be recommended oral medications as select groups of people with central serous chorioretinopathy have been found to respond well to this, however, these will not be suitable for everyone. If your eye specialist considers your condition to be a good candidate for retinal surgery, you may be offered either laser photocoagulation or photodynamic therapy. Laser photocoagulation has been shown to be able to speed up the resolution of central serous chorioretinopathy by up to 2 months. During this retinal surgery technique, a targeted laser is used to induce controlled tissue scarring that works to seal the detachment around the macula while allowing surrounding healthy retinal pigment epithelium tissue to pump away the excess fluid.

Photodynamic therapy also involves the use of a laser, this time to activate an intravenously injected drug that accumulates in the abnormal blood vessels of the eye. Activation of this drug reduces leakage from these vessels and has been demonstrated to decrease fluid accumulation and improve the vision. As with many laser therapies, both laser photocoagulation and photodynamic therapy carry the risk of potential adverse effects. These may include small patches of permanent vision loss from retinal scarring or the induction of the growth of new blood vessels. Your eye specialist is the best person to assess these risks and will only recommend you undergo such therapies if the benefits outweighed the likelihood of encountering further complication from treatment.

 Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.