Retinal Conditions
Central Serous Chorioretinopathy
Central serous chorioretinopathy (CSCR) causes painless blurring of central vision, primarily in young men aged 20-45, but can also affect women, although typically in an older age group.
The most common vision changes noticed are wavy lines, a central gray spot, decreased color vision, and the impression that objects are smaller. The vision changes are due to fluid accumulating underneath the retina, similar to forming a fluid “blister”. If you normally wear glasses, your prescription may change, but avoid buying new glasses while the fluid is still present, as your refraction may be unstable during this time.
What causes CSCR?
While the exact cause is unknown, CSCR is related to the failure of support tissues underlying the retina (retinal pigment epithelium and choroid) which normally keep fluid out of the space below the retina. In most cases, CSCR is not related to an underlying medical condition or medication. However, a common trigger is the use of steroids, including oral steroids (e.g. prednisone), injected steroids (e.g. cortisone), and less-potent steroids such as skin creams (e.g. hydrocortisone) or inhaled medications (e.g. Flonase®️). Medical conditions that increase your body’s production of steroids can also contribute to CSCR, so please let your doctor know if you have a history of Cushing Syndrome. Similarly, high levels of stress raise your body’s steroid level.
In most cases, CSCR is not related to an underlying medical condition or use of medications. Stress and "Type A" personality traits have been associated with CSCR. Steroid use is a common trigger for CSCR, regardless of whether the steroids are taken by mouth, by injection, by eyedrops, by inhaler, or by topical application. Other associations include organ transplantation, Cushing syndrome, hypertension, systemic lupus erythematosus, pregnancy, and use of some medications.
How is CSCR diagnosed and monitored?
Your BARA doctor may recommend diagnostic testing to confirm CSCR and distinguish it from other conditions that cause fluid to accumulate under the retina. Optical coherence tomography (OCT), uses laser light to scan the central retina and provides a cross-sectional view to show fluid. An OCT is often ordered at each visit to monitor progress. Photographs and a fluorescein angiogram (FA) may also be ordered to demonstrate the source of the fluid. FA uses a mineral-based dye that fluoresces when activated by certain wavelengths of light in order to visualize the retinal blood vessels. Your BARA doctor will review your imaging results with you.
Complications of CSCR
For most, CSCR will resolve without treatment or significant vision loss within 3 months of developing symptoms. However, about 30% of people will develop a recurrence within 1 year. In 15% of patients, fluid remains longer than 6 months. In addition, 25-50% may develop CSCR in the other eye. About 5% of patients may develop a complication known as choroidal neovascularization that requires regular injections of medication into the eye.
How is CSCR treated?
The first “treatment” typically consists of observation, stress-reduction, and stopping any steroids you may be taking. If you have been prescribed steroids by another physician, your BARA doctor will work with your other care providers to find the safest solution.
Further therapy is typically initiated for individuals with fluid persisting longer than 6 months, but may be started sooner in individuals experiencing vision loss or in those with specific professional demands or only one eye. Eyes with repeated episodes of CSCR can be particularly challenging to treat.
Treatment has been shown to shorten the time to visual recovery, but does not change the final visual outcome. Your BARA doctor may recommend treatments including laser (such as focal laser or photodynamic therapy), oral medications (such as diuretics), or injections into the eye. Surgery is generally not a treatment option for CSCR. Your BARA doctor will discuss treatments that may be appropriate in your case.
Color photographs and fluorescein angiography images showing a blister of subretinal fluid (arrows) with a central source of leakage (central white spot which enlarges into a plume) due to central serous.
