Central Serous Retinopathy

Overview

Central serous chorioretinopathy (CSR) is a retinal disorder of unknown cause that affects the central portion of the retina called the macula. In CSR, fluid leaks from beneath the macula, causing elevation of the tissue, thereby leading to a disturbance of vision.

CSR typically occurs in men (85-90% of cases) between the ages of 25-45, although younger and older patients may also develop the disease. It is uncommon in African-Americans. Patients with CSR have also been reported to be more likely to have a Type A personality, i.e. stressed, pressured, energetic type people. Other risk factors include pregnancy and the use of corticosteroids. It is also important to note that 20%-30% of patients with CSR may eventually develop the disorder in the other eye, and that a similar percentage of patients may have recurrences of CSR, anywhere from months to years later.

While the underlying cause is unknown, it is believed that CSR begins with the development of leakage in the choroid, the tissue underlying the retina. When the pressure from the fluid builds up enough, this can cause a disruption of the retinal pigment epithelium (RPE) which is a layer of cells that serves as a barrier between the choroid and the retina. Fluid can then break through and lead to a blister of fluid beneath the macula.

Signs and Symptoms

Some cases of CSR may be asymptomatic because the blister of fluid does not involve the central portion of the macula, and so is not noticed by the patient. The vast majority of patients seen, of course, have symptoms. These may include:

• blurry central vision

• blind spot in central vision

• distortion of vision

On examination, the ophthalmologist may see blister-like elevations of the retinal pigment epithelium and/or retina, as well as alterations of the normal pigmentation of the retina. A key part of the diagnosis involves the use of fluorescein angiography, in which a dye is injected into a vein in the arm, and photographs are taken as the dye travels through the retinal blood vessels. Patients with CSR will typically demonstrate varying degrees of leakage from the area of retinal pigment epithelial disruption.

Treatment

There is no effective medical therapy for patients with CSR. The only treatment of proven benefit is laser photocoagulation in which the area that is leaking is treated with the laser. Fortunately, most patients with CSR will experience resolution of leakage and return of vision without treatment (90% or more will attain 20/30 vision). It is for this reason that most ophthalmologists will elect to wait several months before treating a patient with CSR. Laser treatment is not without potential risks and side effects, including the development of a blind spot at the area of treatment, hemorrhage, or rarely, loss of vision. Each case must be approached on an individual basis. The ophthalmologist must take into account numerous factors, including the level of disability the patient is experiencing, proximity of the area of leakage to the center of the macula, duration of symptoms, and any past history of CSR.

Even with return of 20/20 vision however, some patients may notice some mild permanent abnormalities in their vision, such as decreased contrast sensitivity, mild distortion, and problems seeing at night.