Central Serous Chorioretinopathy

What is central serous chorioretinopathy?

In CSC, fluid leaks from the layer of blood vessels beneath the retina (the choroid) and collects under the macula, the center of the retina responsible for sharp, detailed vision. The fluid lifts a small area of the retina, like a blister, which distorts and blurs what you see. The condition is sometimes called central serous retinopathy or CSR.

CSC is one of the more common retinal conditions in younger adults. Men are affected more often than women, and it usually appears between the ages of 30 and 50, although it can occur at any age.

What causes it?

The exact cause is not fully understood, but several factors are clearly linked to it:

• Corticosteroids. Steroid medication in any form (pills, injections, inhalers, nasal allergy sprays, skin creams, even some joint injections) can trigger or worsen CSC. This is the single most important factor we ask about.
• Stress. CSC is associated with periods of emotional stress and with "type A" personalities. One explanation is that stress raises the body's own natural steroid hormones.
• Other medications and conditions. Stimulants, decongestants, erectile-dysfunction medications and certain cancer drugs have been linked to CSC, as have high blood pressure, heart disease, sleep apnea and pregnancy.
• Family history. About half of patients have a relative with signs of CSC on a retinal exam, suggesting an inherited tendency.

Please tell your doctor about every medication and supplement you take, including over-the-counter sprays and creams.

Symptoms

• Blurred or dim central vision, usually in one eye
• A dark or gray spot in the center of your vision
• Straight lines that look bent or wavy
• Objects that appear smaller or farther away than they are
• Colors that look washed out, or a brownish tint

Some people have no symptoms at all, especially when the fluid is away from the very center of the macula. A careful exam often finds subtle changes in the other eye as well.

How is it diagnosed?

CSC is diagnosed with a dilated examination of both eyes and retinal imaging. An OCT scan, a painless, non-contact scan that shows the retina in cross-section, reveals the pocket of fluid under the retina, even when it is very small, and lets us measure it precisely at each visit. In some cases we also perform fluorescein angiography, a dye test that shows the exact point of leakage and distinguishes CSC from other conditions that cause fluid in the macula, such as wet macular degeneration.

How is it treated?

Observation. Most episodes of CSC resolve on their own within two to four months, and vision usually recovers well. For a first episode, the usual approach is to monitor with OCT scans, stop any steroid exposure, and address contributing factors such as stress and sleep.

Stopping steroids. If you are taking a corticosteroid in any form, we will work with the prescribing physician on whether it can be stopped or changed. Never stop a prescribed steroid abruptly on your own; high-dose steroids must be tapered.

Treatment for persistent or recurrent CSC. When fluid lasts longer than a few months, keeps coming back, or threatens lasting damage to the macula, treatment is recommended. The main treatment is photodynamic therapy (PDT), sometimes called a "cold laser": a light-activated drug is given through a vein in the arm and then activated by a low-energy laser aimed at the leaking area, which seals the leak and reduces the chance of recurrence. The procedure is done in the office and takes about twenty minutes. Your doctor will discuss whether and when treatment makes sense based on the location of the leak and how long the fluid has been present.

With early diagnosis and appropriate care, the great majority of patients with CSC keep good vision. The main risks come from untreated chronic fluid, which can thin and permanently damage the macula. That is why follow-up matters even when symptoms are mild.