What Is Central Serous Retinopathy?

Medically Reviewed by Poonam Sachdev on August 24, 2022
Written by Amber Felton
5 min read

Central serous retinopathy (or CSR, also known as central serous chorioretinopathy, or CSCR), is a disease of the eye, most notably the retina. This condition results from fluid building up underneath the center of the retina: i.e., the macula. This fluid leaks from the choroid, a blood vessel layer located underneath the retina. When this fluid leaks, it is often due to the macula becoming separated from the eye, giving the fluid enough space to build up. 

Men are more commonly affected than women, with the disease most often affecting those who are 25 to 50 years old. 

The exact trigger of central serous retinopathy is unknown, but it is thought that CSR can result from exposure to a corticosteroid drug that can be found in nose sprays for allergies and creams that have anti-inflammatory skin properties. There is also suspicion that corticosteroid drugs can also cause CSR to worsen if you have already been diagnosed with this condition. 

There is also reasonable suspicion that patients experiencing emotional distress or type A personalities who are more likely to experience chronic stress are at an increased risk of developing CSR. This is because the body may produce natural corticosteroids in stressful situations, which may end up resulting in CSR. 

Risk Factors for CSR

Around half of patients who have been diagnosed with CSR have one or more relatives that also have the disease, according to retinal examinations. This means that, although there have been no patterns identified when it comes to specific inheritance patterns, there may be a genetic risk factor involved in the development of CSR. 

In addition, the risk of developing CSR increases for patients who have high blood pressure or heart disease, as well as those who are currently pregnant or have had a recent pregnancy. 

There is also evidence that other drugs aside from corticosteroids may increase the risk of developing CSR. These drugs include stimulants, erectile dysfunction medications, decongestants, and some anti-cancer agents. 

Symptoms of CSR include: 

  • Central vision that has become blurred, dimmed, or distorted
  • Central vision that has developed a dark area 
  • An affected eye that may see straight lines as irregular, crooked, or bent 
  • Perception of objects as seeming to be smaller or further away
  • Perception that white objects appear dull in color or have a brownish tinge

Diagnosing central serous retinopathy is complicated and may warrant several visits to your doctor. During the diagnosis, your doctor will perform a complete dilated eye examination in both eyes. They will take imaging of the retina and may take retinal photographs. 

There are two main tests that can be used to diagnose CSR: 

  • Optical coherence tomography (OCT): OCT is a scan of the retina. It allows your doctor to view your retina at a microscopic level, making it possible to identify minuscule pockets of fluid or retinal scarring. This is helpful for those with acute or chronic CSR. 
  • Fluorescein angiography: For this test, a vein in the patient’s arm is injected with a dye. Pictures are then captured of both eyes that will reveal leakage of the dye beneath the patient’s retina. Along with OCT, this test allows your doctor to diagnose CSR and to tell it apart from other retinal diseases.

Most of the time, CSR clears up on its own without any medical intervention. The fluid is often reabsorbed, and conditions return to normal. Most patients with CSR will also notice that their vision is restored. 

If, after six months, the fluid remains and has not been reabsorbed on its own, further treatment may be necessary to prevent more lasting damage to the macula. 

Treatment Options

The most common treatment for CSR involves using a laser to seal the leak. This treatment is not to be used too close to the center of the macula, though, as that can result in central vision damage. 

In instances where the fluid is too close to the center of the macula, another treatment option called photodynamic therapy may be suggested. For this treatment, a drug is injected through your bloodstream, eventually reaching the eye. Then, the drug is activated using a low-energy laser that won’t harm the macula. 

Lastly, lifestyle changes may need to be adopted to help reduce stress. You may also be required to stop taking any drugs that could cause CSR to worsen. 

The overall prognosis of CSR is generally good. A patient’s vision usually recovers on its own within a few weeks or months without treatment. 

Your doctor will decide on the best treatment plan for your specific CSR needs, though, depending on how severe your symptoms are and when they began. 

It is helpful to detect CSR early, and most patients can receive successful treatment which will help them in avoiding permanent vision impairment. 

If you suspect that you are dealing with central serous retinopathy, it’s important to consult your doctor. The path to a diagnosis can be long and complicated, and oftentimes, you will need more than one appointment in order to get a proper diagnosis.  

In order to be prepared for your first visit, consider the following:

  • Have a list of questions and concerns prepared with the most important questions listed at the top. Understand that there may not be enough time to tackle all the questions or concerns you have during your first visit, so putting the important ones first will help. 
  • Ask questions regarding any symptoms you are experiencing, as well as any diagnoses, tests, and treatment options available. 
  • Be sure to talk to your doctor during further visits regarding any questions or concerns that you were unable to address in the initial visit. 
  • Questions should consider changes in the quality of life and any health goals.
  • Take notes at the appointments in order to keep from forgetting anything that was discussed.
  • Consider keeping a journal of symptoms you are experiencing so that you can discuss them with your doctor. You could keep a paper journal of symptoms or make a voice memo on your smartphone to record each symptom. To help your doctor fully understand your symptoms, be sure to include details such as when the symptom started and ended, how often similar symptoms happen, and if anything makes it better or worse. You’ll also want to note whether these symptoms affect your daily life and prevent you from doing your usual tasks.