Central Serous Retinopathy

About Central Serous Retinopathy

Central serous retinopathy (CSR) affects the central area of your retina, known as the macula. CSR can cause your vision to be blurry and distorted due to fluid collecting underneath your macula. Objects often appear smaller and distorted in the affected eye.

In most people, CSR gets better on its own and doesn’t cause long-term changes to vision. In some people it may re-occur. The more times someone has CSR, the higher the chance of having some permanent changes in your vision.

Central serous retinopathy is also called central serous chorioretinopathy

How the eye works

When you look at something, light passes through the front of your eye, and is focused by the cornea and lens, through the vitreous gel, onto your retina. The retina is a delicate multi-layered tissue that lines the inside of your eye. It receives nourishment from the choroid layer beneath it. The sensory part of the retina contains the light sensitive cells and its supporting layer contains the retinal pigment epithelium. The retina converts light into electrical signals that travel along the optic nerve to your brain. The brain interprets these signals to "see" the world around you.

Light is focused onto a small central area of the retina called the macula. This highly specialised part of the retina is vital, because it enables you to see fine detail when you are looking directly at something such as words, photos or the television. Your macula is also important for colour vision. The rest of the retina, gives you side vision (peripheral vision).

How CSR can affect your eye and vision

Your 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.

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 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.

CSR usually occurs in one eye and can affect men or women. However, it tends to affect mainly young to middle age men, aged 20-45 years old.

What causes CSR?

Often CSR is idiopathic which means no cause is found to explain why it occurred.

However, several possible risk factors have been identified. The condition seems to occur more frequently in people:

  • with a Type A personality (individuals who are stressed and find it hard to relax)
  • who use steroid medication
  • during pregnancy
  • with Cushing syndrome

When you are under stress, your body releases a natural steroid into your bloodstream called cortisol which helps your body to cope.

Although cortisol is essential for your health, raised levels of cortisol can sometimes cause problems for your 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 CSR.

In most cases of CSR, the cause is unknown.

How is CSR diagnosed?

The ophthalmologist or eye doctor at the hospital will make the diagnosis of CSR. The ophthalmologist will examine your eyes using a microscope called a slit lamp. In order to examine the retina and macular area more easily, your pupils will be dilated with eye drops that take about 30 minutes to work; the effect of the drops usually wears off in about 6 hours. Often further testing will be required to confirm the diagnosis of central serous retinopathy including fluorescein angiography and / or optical coherence tomography (OCT) imaging.

A fluorescein angiogram is a way of taking pictures of the network of blood vessels at the back of your eye. This allows the ophthalmologist to see where and what extent of leakage is present. Before a series of pictures is taken, an orange dye is injected into your arm which travels through the blood to your eye. This usually isn't painful but can make some people feel sick.

Once the dye has been injected you will be asked to position yourself and look at a special camera. The machine takes pictures of the back of your eye as the dye is travelling through the blood vessels. You will experience a series of flashing lights as the pictures are taken, but the test is not painful. It usually takes about 10 minutes.

An OCT scan may also be used to diagnose and monitor your condition. An OCT is a type of scan that gives a cross sectional image of the retina which helps the ophthalmologist determine how much fluid and swelling is present. Drops would be required to dilate your pupil and then you would be asked to sit in front of the OCT. You would need to keep still while your eye is scanned by the machine. It is a painless and very quick procedure without touching your eyes that takes a couple of minutes to complete.

What is the prognosis?

Generally speaking, CSR’s progress can be grouped into 3 categories.

  1. Most people will recover within 4-6 months without any need for treatment.
  2. CSR lasting up to 12 months and requiring treatment
  3. CSR lasting over 12 months which is very rare and can cause RPE detachment or bullous retinal detachment.

Treatment is not usually needed for CSR. Most people will find that their vision will improve within 3-6 months and without the need for treatment. Vision often returns to how it was before CSR developed, although in some people small changes to vision may persist. About 30-50 % of people will have a recurrence either in the same or fellow eye.

In a minority of people, the condition can be chronic, lasting longer than 12 months. In these cases, sight is more at risk because the retinal layers at the back of your eye can become damaged. As a result treatment may be recommended for CSR lasting longer than 6 months.

In rare cases, central serous retinopathy with bullous serous retinal detachment can occur; in this type of retinal detachment fluid collects under the retina and away from your central macula without causing the retina to break. It is important for the condition to be diagnosed so that the appropriate treatment options can be explored.

How is CSR treated?

The majority of people with CSR do not require treatment. If, however, treatment is required, thermal laser may be used or photodynamic therapy.

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.

The other treatment option 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 would only be considered after 4-6 months of the initial diagnosis.
  • If you experience recurrence then treatment may be considered sooner.
  • Laser treatment is not given 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 that may be considered in the future are antivascular endothelial growth factor medication (Anti VEGF), anti-inflammatory drugs and anti-steroid medications. Your ophthalmologist is the best person to advise you about suitable treatment options for your situation.

Following up with your GP

Under the care of your GP, it would be advisable to stop taking any medication containing steroids, if possible; this would include medications taken by mouth, inhaled and applied to the skin. Counselling for stress management and lifestyle changes are also important considerations when you have CSR.

Coping with your diagnosis

Being diagnosed with an eye condition can be very upsetting. You may find that you are worried about the future and how you will manage with a change in your vision. All these feelings are natural.

Some people may want to talk over some of these feelings with someone outside their circle of friends or family. RNIB can help, with our telephone helpline and our emotional support service. Your GP or social worker may also be able to help you find a counsellor if you think this would help you.

The Macular Society has local groups which meet throughout the country and also offer a telephone counselling service. Sometimes it can help to talk about your feelings or share your experience with people who may have had similar experiences.

Help to see things better

Having chronic central serous retinopathy can cause changes to your vision in the long term, but much can be done to help you make the most of your remaining vision and adapt to any changes.

There are lots of things that you can do to make the most of your remaining vision. This may mean making things bigger, using brighter lighting or using colour to make things easier to see. There is more about this in our publication, "See for yourself: make the most of your sight" which is available from our Helpline on 0303 123 9999.

You can also ask your ophthalmologist, optician or GP to refer you to your local low vision service, which can provide you with magnifiers to help with reading and advice on lighting to help make the most of your sight. Local social services should also be able to offer you information on being safe in your home and getting out and about safely. They should also be able to offer you some practical mobility training to give you more confidence when you are out.

Our Helpline

Our Helpline can also give you information about low vision clinics and the help available from social services on 0303 123 9999.

They can also offer help if you have any difficulties accessing these services.We offer lots of practical information about adapting to changes in your vision and products that make everyday tasks easier.