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 that alters the function of the retina. Symptoms become apparent when central vision is affected. CSR most commonly occurs in males aged 30 to 50. The cause of CSR is unknown, although in some patients it is associated with corticosteroid use including inhalers or skin creams. The condition is commonly related to stress or “type A” personalities. 

Fundus photo of CSR showing a blister of fluid

Fundus photo of CSR showing a blister of fluid

Symptoms

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

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Evaluation

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

Fluorescein angiography

Fluorescein angiography

Treatment

In the majority of cases, no treatment is required since the condition usually resolves spontaneously over several months. In some instances, 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, an in-office procedure in which medication is given systemically and activated by laser when reaching the retina, is effective in stopping leakage for individuals whose CSR has failed to resolve spontaneously.  

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Prognosis

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

OCT of CSR showing subretinal fluid

OCT of CSR showing subretinal fluid