Central Serous Chorioretinopathy: Symptoms, Who is at Risk, Treatment, Diagnosis

The Central Serous Chorioretinopathy is a condition where fluid builds up under the retina of the eye. This leads to a distorted vision. Men are more likely to develop this condition than women. A common reason for developing Central Serous Chorioretinopathy is stress, although, there are many other reasons too. This condition, most of the times, gets treated on itself; however, there are other treatment options available for chronic cases which do not resolve on their own.

Central serous chorioretinopathy is a condition in which fluid builds up beneath the retina of the eye, leading to distorted vision. This is a condition that often occurs in men and mostly related to stress. The fluid leakage comes from a layer of tissue under the retina, called the choroid. There is another layer of cells called the retinal pigment epithelium (RPE). When the RPE doesn’t work as it should, fluid builds up under the RPE. As a result, a small detachment forms under the retina causing vision to become distorted. Let’s have a look at the structure of the eye to have a better understanding of this condition.

As the image depicts, the retina is made up of a number of layers including a layer called the retinal pigment epithelium (RPE) that separates the sensory retina from the choroid. The RPE prevents fluid and blood from the choroid entering under your retina.

Central Serous Chorioretinopathy or CSR may happen when there is a small break in the RPE. Fluid starts to collect underneath your retina which causes the central macula area to swell.

The swelling which is caused by the fluid collection underneath the retina can cause blurry vision, distortion, blind spots and objects appearing smaller than they are. You may also have trouble with bright light and contrast sensitivity could be reduced, which is how well you can see an object from its background. Sometimes the swelling may not cause you any visual symptoms.

Typically, a patient with Central Serous Chorioretinopathy will come in with complaints of decreased central vision with distortion as well. They may also have prolonged after-images where they see green or purple images.

Symptoms of central serous chorioretinopathy can include:

• Dimmed, blurred, or distorted central vision.
• A dark area in your central vision.
• Straight lines may appear bent, crooked or irregular in your affected eye.
• Objects may appear smaller or further away than they are.
• When you look at a white object, it may appear to have a brownish tinge or appear duller in color.

Men in their 30s to 50s are more likely to develop central serous chorioretinopathy than women. Stress is a major risk factor. People under a lot of stress may be more likely to develop central serous chorioretinopathy.

Other risk factors for central serous chorioretinopathy are:

• People who have use steroids by mouth, through a vein or even inhaled
• Helicobacter pylori infection; a type of bacteria that can infect the stomach
• Autoimmune disease when the body attacks its own tissues
• Sleep disturbances like insomnia which means having trouble falling asleep or staying asleep
• Type A behavior which means aggressive and competitive behavior
• Hypertension
• People who have Cushing syndrome naturally secrete high cortisone and hence are at risk for developing central serous chorioretinopathy
• When someone is under stress, their body releases a natural steroid into the bloodstream called cortisol which helps their body to cope.

Although cortisol is essential for our health, raised levels of cortisol can sometimes cause problems for our body. This can include immune suppression (reducing the body’s ability to fight infection) and increased fragility and permeability of the blood vessels.

Although cortisol is currently thought to be linked to CSR, it is not thought to be solely responsible for the condition and cannot explain all cases of central serous chorioretinopathy. Mostly, the central serous chorioretinopathy is idiopathic.

The eyes are first examined by the ophthalmologist and this is done by dilating your eyes with eye drops. The eye drops take about 30 minutes to work and the effect of the eye drop wears off in about 6 hours. Often further testing is required to confirm the diagnosis of central serous chorioretinopathy including fluorescein angiography and/or optical coherent tomography.

The ophthalmologist will take special photographs of your eye. During fluorescein angiography, a dye is injected into a vein in your arm. The dye travels throughout the body, including your eyes. Your doctor takes photographs of your eye as the dye passes through the retinal blood vessels. The orange dye will show abnormal areas in your eye. This can help find areas with central serous chorioretinopathy.

Optical coherence tomography (OCT) also helps your doctor look at the retina. A machine scans the back of the eye and provides detailed three-dimensional pictures of the retina. This helps measure retinal thickness and find swelling of the retina. Drops would be required to dilate the pupil and you would be asked to sit in front of OCT. The patient is asked to stay still while the eye is being scanned by the machine. The process is painless and quick.

Most cases of central serous chorioretinopathy clear up in one or two months without any treatment. If, however, treatment is required, thermal laser may be used or photodynamic therapy. During this time, your ophthalmologist will look at your eye to see if the liquid is going away. Sometimes there is severe vision loss or the leakage does not go away. In these cases, laser treatment or photodynamic therapy may be used. These treatments can seal the leak and restore vision. In conventional thermal laser, the ophthalmologist would apply the laser to the macula and it would seal off the leakage. This treatment would not be used if the leakage occurs in the fovea which is the central area of your macula as it leaves a scar that would impact on your vision.

Most people with central serous chorioretinopathy regain good vision even without treatment. But vision may not be as good as it was before the condition. About half of patients who have had central serous chorioretinopathy will have it return. It is important to have regular follow-up exams with your ophthalmologist. This is because long-term fluid accumulation can lead to permanent vision loss.

The other treatment option for central serous chorioretinopathy is photodynamic therapy (PDT). PDT is a type of laser treatment which uses a combination of a light sensitive drug called Verteporfin (Visudyne) and a low energy laser to reduce the leakage. This form of treatment is unlikely to damage the centre fovea and surrounding tissue. Some considerations include:

• Treatment for central serous chorioretinopathy should only be considered after 4-6 months of the initial diagnosis.
• If the patient experiences recurrence of central serous chorioretinopathy then treatment may be considered sooner.

Laser treatment is not given for central serous chorioretinopathy if the fluid is leaking too close to the centre of the macula because it could cause more harm than good. Other possible treatment options for central serous chorioretinopathy that may be considered in the future are antivascular endothelial growth factor medication (Anti VEGF), anti-inflammatory drugs and anti-steroid medications. It is always best to discuss your condition with your ophthalmologist as he/she is the best person to advise you about suitable treatment options for your situation.