Central Serous Retinopathy

Central Serous Retinopathy (CSR) is a condition in which a small pool of fluid accumulates under the macula. A defect in the normally water tight layer beneath the retina allows the leakage of fluid which then collects under the retina. This forms a blister-like elevation which alters the function of the retina. Symptoms become apparent when central vision is effected. CSR most commonly occurs in males in their 30’s to 50’s. The cause of CSR is unknown, although in some patients it is associated with corticosteroid use, including inhalers or skin creams. CSR has been commonly associated with stress or “type A” personalities.

The symptoms of CSR are blurred vision, distortion, or a central grey or dark spot. Vision can range from 20/20 to 20/200. Color vision may also be effected.

The diagnosis of CSR is usually made by its characteristic clinical appearance. Fluorescein Angiography may be necessary to confirm the diagnosis. In Fluorescein Angiography, a dye is injected into an arm vein, and photos are taken as the dye passes through the retinal blood vessels. During this test the defect in the layer beneath the retina can be identified, as leakage of dye is typically seen. Optical Coherence Tomography (OCT) which shows a slice of retina in cross section is useful in diagnosing CSR.

In the majority of cases no treatment is required, and the condition resolves spontaneously within several months. In some cases, laser treatment to seal the leakage source can speed resolution of the fluid blister and improve vision. Behavior modification may be recommended if stress is thought to be a contributing factor. Photodynamic therapy, typically used in the treatment of Wet AMD, is effective is resolving leakage in individuals whose CSR has failed to resolve spontaneously.

The prognosis for CSR is generally excellent. Over 90% of patients regain 20/30 vision or better within 6 months. In some people, the condition will resolve leaving very subtle visual imperfections. Patients with CSR should avoid corticosteroid use including pills, creams, and inhalers. In a small minority of patients, CSR may become a recurrent problem.

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