Central Serous Chorioretinopathy

Central serous chorioretinopathy is a condition in which fluid builds up beneath the retina, causing blurred or distorted vision. While it most commonly affects young and middle-aged adults and often resolves on its own, understanding this eye condition and its triggers can help protect your sight.

Table of contents

• What is Central Serous Chorioretinopathy?
• Other Names for This Condition
• Who is Affected?
• Symptoms
• Causes and Risk Factors
• How Doctors Diagnose the Condition
• Treatment Options
• Outlook and Recovery

What is Central Serous Chorioretinopathy?

Central serous chorioretinopathy, commonly called CSC or CSCR, is a condition in which fluid accumulates under the retina, causing a fluid-filled separation and vision loss^[1]. The retina is a layer of tissue at the back of your eye that senses light and sends signals to your brain so you can see^[2].

The fluid comes from a layer of blood vessels beneath your retina called the choroid^[2]. When this fluid builds up, it can cause your retina to detach from the tissue behind it, leading to vision problems^[2]. This separation usually occurs at the macula, which is the central part of the retina responsible for sharp, detailed vision needed for activities like reading and recognizing faces^[1].

central serous retinopathy, central serous choroidopathy, CSC, CSCR

Other Names for This Condition

This eye condition is known by several names. Healthcare providers may refer to it as central serous retinopathy, central serous choroidopathy, or simply use the abbreviations CSC or CSCR^[2][3].

Who is Affected?

Central serous chorioretinopathy most often occurs in young and middle-aged adults, typically between the ages of 20 and 50^[1][4]. For reasons that are not fully understood, men develop this condition more commonly than women. In fact, men are affected about six times more often than women^[8].

The condition affects about 10 out of every 100,000 people, depending on sex and other risk factors^[2]. CSC most commonly affects one eye, though careful examination often reveals some involvement in the other eye as well^[1]. In some cases, both eyes can be affected at the same time^[2].

Symptoms

The most common symptom that patients experience is blurry central vision, which often occurs in one eye^[1]. However, depending on the location and amount of fluid beneath the retina, CSC can show no symptoms at all, especially if the affected areas fall outside of the macula^[1].

When symptoms do occur, they may include:

• Blurry vision, like a smudge in the center of your sight^[2]
• A dark spot in the center of your vision^[2]
• Darker or dim vision^[2]
• White items looking dull or somewhat brown^[2]
• Objects appearing smaller or farther away than they actually are^[2]
• Straight lines looking crooked or bent^[2]
• Distorted vision or changes in how you see details^[5]

Some people with central serous chorioretinopathy do not experience any vision problems. This means it is possible to have the condition without knowing it^[2].

Causes and Risk Factors

The causes of CSC are not fully understood. Scientists do not completely know why the retina becomes separated from the tissue behind it and fluid builds up^[1].

Stress and Personality Type

Stress appears to play a key role in this condition. When your body is stressed, it releases a hormone called cortisol, which can cause inflammation and fluid leakage^[2]. People with high stress levels and reduced coping skills are at higher risk for central serous retinopathy^[2].

An association has also been made between CSC and patients with emotional distress or “type A” personalities—people who tend to be aggressive, competitive, and have a sense of urgency^[1][4]. It is possible that the body produces natural corticosteroids in times of stress that may trigger CSC in people prone to this condition^[1].

Corticosteroid Use

There is a definite association between CSC and exposure to corticosteroid drugs^[1][4]. It is thought that any exposure to a corticosteroid drug can bring about or worsen CSC. Corticosteroids are found in allergy nose sprays and anti-inflammatory skin creams available over the counter, and are often prescribed to treat a variety of medical conditions^[1].

While CSC is generally associated with oral or intravenous steroid use, studies have also reported the condition after nasal spray, topical skin creams, joint injections, epidural injections, or injections around the eye^[4].

Other Risk Factors

Several other factors can increase your risk of developing central serous chorioretinopathy:

• Being male and between the ages of 30 and 50^[2]
• Having nearsightedness (myopia)^[2]
• High blood pressure or heart disease^[1][2]
• Current or recent pregnancy^[1][2]
• Autoimmune diseases, such as lupus and rheumatoid arthritis^[2]
• Kidney disease^[2]
• Infection with the bacterium Helicobacter pylori^[2][4]
• Sleep problems, like sleep apnea and insomnia^[2]
• Use of certain medications, including those that treat nasal congestion and erectile dysfunction^[2]
• Use of stimulants, decongestants, or some anti-cancer agents^[1]

About half of patients diagnosed with CSC have at least one relative with signs of the disease on retinal examination, indicating there may be a genetic tendency. However, no specific inheritance pattern has been identified^[1][4].

How Doctors Diagnose the Condition

If you have changes to your vision, you should seek medical attention from your primary care provider or an eye specialist called an ophthalmologist^[2]. Your doctor will conduct a complete eye examination with dilated pupils in both eyes and will obtain imaging of the retina^[1].

Diagnostic Tests

Several tests may be used to diagnose central serous chorioretinopathy:

Optical coherence tomography (OCT) is a retinal scan that is very helpful in diagnosing CSC. It enables your doctor to see the retina at the microscopic level, making it possible to identify very small pockets of fluid or retinal scarring^[1]. This scan provides three-dimensional pictures of your retina so your provider can measure retinal thickness, identify swelling, and detect fluid separation^[2].

Fluorescein angiography is a test in which a dye is injected into a vein in your arm and pictures are taken of each eye to detect characteristic leakage of the dye beneath the retina^[1][2]. This test, along with OCT, allows your doctor to make the diagnosis of CSC and to distinguish it from other retinal diseases causing fluid in the macula^[1].

Retinal photographs may be taken to document the appearance of the disease^[1]. Your doctor will also check your vision using eye charts and perform other basic eye examinations^[5].

Treatment Options

Many cases of central serous retinopathy go away on their own over a few weeks or months. Your healthcare provider may recommend monitoring, or a “watch and wait” approach. During this monitoring period, they will repeat tests to ensure the fluid is draining^[2].

CSC is typically a self-limiting disease, and visual recovery usually occurs within a few weeks to months without treatment^[1]. Most cases clear up without treatment in one to two months^[5].

Medication Changes

If you are taking corticosteroids of any kind, you should discontinue their use if possible. However, you should only do this after checking with the doctor who prescribed them to ensure it is safe to stop^[1][2]. Suddenly stopping high-dose steroid medications can cause medical problems^[1].

Treatment for Persistent Cases

When the condition persists for more than three to six months, or when long-standing fluid accumulation causes damage, several treatment options may be considered^[1][6]:

Photodynamic therapy (PDT) is a “cold laser” treatment that is effective and often used to treat the source of fluid leakage under the retina in chronic CSC^[1]. With photodynamic therapy, a drug called verteporfin is injected into the arm, where it travels to the eye. The verteporfin is activated by shining a special cold laser on the source of leakage^[1].

Current evidence supports half-dose or half-fluence verteporfin photodynamic therapy as the treatment of choice for CSC^[8][11]. This reduced-fluence PDT is as effective as standard-fluence PDT but safer, with less damage to surrounding healthy tissue^[6].

Laser treatments may help restore vision in people with more severe leakage and vision loss^[1][5]. Thermal laser treatment or micropulse laser photocoagulation can be used in some cases^[11].

Oral medications have also been used to treat CSC. Some studies have looked at medications called mineralocorticoid receptor antagonists^[4][11].

Eye injections may be used in certain situations. A subset of patients with chronic CSC can develop abnormal blood vessel growth, and these patients should be treated with drugs that block vascular growth factors^[8].

Outlook and Recovery

Most people recover good vision without treatment^[5]. The majority of people with CSC will regain most or all of the sight they had before^[1].

However, vision is often not as good as it was before the condition occurred^[5]. The disease returns in about half of all people^[5]. Vision loss is usually temporary but sometimes can become chronic or recur^[1].

When fluid is still present after three to six months, you may need treatment to prevent more lasting damage to the macula^[1]. Rarely, people develop permanent scars that damage their central vision^[5].

Early detection and management of CSC can lead to successful treatment and no long-term vision loss. If you have been diagnosed with central serous chorioretinopathy or experience any vision changes, it is important to follow up regularly with your eye doctor^[1].