Central serous retinopathy (CSR)

CSR usually affects people aged between 20 and 50, but it can also occur in older people. It is more common in males than females. For most people, CSR gets better on its own and doesn’t cause long-term changes to vision. In some people, it may recur. Episodes of CSR that last for a long time or keep coming back are more likely to cause permanent changes to vision.

This page contains a summary of our information on CSR. To read our full information, download our factsheet:

Swelling at the macula can cause changes to your central vision such as:

• blurring
• distortion
• blind spots
• dulled colour vision
• seeing objects that appear to be smaller than they actually are
• increased sensitivity to light
• problems seeing an object against a background of a similar colour
• fluctuating vision from one day to another.

In most cases, doctors are unable to find a cause for CSR. This is known as idiopathic CSR. There are some risk factors that may trigger CSR in some people. The condition seems to occur more frequently in people:

• with a Type A personality (people who are more highly competitive, are continually stressed and find it hard to relax)
• who use steroid medication
• who are pregnant
• with Cushing syndrome: a condition caused by too much of a hormone called cortisol in the body
• with H. pylori bacterial infection: a type of bacteria that can infect the stomach lining and cause stomach ulcers
• sleep apnoea syndrome: a condition that causes breathing to stop and start during sleep
• with untreated high blood pressure (hypertension)

When you’re under stress, your body releases cortisol into your bloodstream. Cortisol is a natural steroid which helps your body to cope. Conditions such as pregnancy, sleep apnoea and Cushing syndrome can cause higher levels of cortisol.

Cortisol is essential for your health. However, high levels of cortisol over time can make the blood vessels more fragile and cause them to leak.

Although cortisol is currently thought to be linked to CSR, it is not thought to be the only reason for the condition. High cortisol cannot explain all cases of CSR.

The way CSR may progress can be grouped into three categories.

• Most people will recover within four to six months without any need for treatment.
• CSR which lasts longer, or recurs may require treatment
• CSR which lasts for years and causes damage to the retinal pigment epithelium (RPE). The RPE is a layer of cells behind the retina that forms a barrier between the retina and the underlying blood supply. If the RPE is damaged it is unable to prevent fluid building up underneath the retina. This build-up of fluid causes the retina to become swollen.

Usually, treatment isn’t needed for CSR that gets better on its own. Often people can see better within three to six months without the need for treatment.

In a small number of people, CSR can be chronic. This means it lasts a long time which can cause permanent changes in the RPE. Sight is more at risk in these individuals. This is because the prolonged swelling can damage the layers of the retina at the back of the eye. This can lead to a permanent worsening of vision. Treatment may be recommended for CSR lasting longer than six months.

Most people with CSR don’t require treatment. They will be monitored as the CSR recovers on its own. This is usually within the first six months. If your CSR doesn’t improve, you may be offered treatment. There are various treatment options that may work in managing the condition. Your ophthalmologist (hospital eye doctor) may recommend thermal laser or photodynamic therapy (PDT).

When deciding on treatment, the ophthalmologist would consider:

• How long you have had CSR. Treatment may be considered after four to six months from the initial diagnosis.
• If you experience a recurrence of CSR, treatment may be considered sooner.
• If the fluid is leaking too close to the centre of the macula, thermal laser treatment can't be given. This is because it could cause more harm than good.

These treatments aim to reduce or resolve the fluid collected under the retina. They cannot restore any damaged cells in the retina.

Most people with CSR find that their vision gets better on its own. Many people aren’t left with long-term changes to their sight. However, having chronic CSR can cause changes to your vision in the long term. If this happens, there are lots of things you can do which will help you adapt to make the most of the vision you still have.

If the eye with CSR was your good eye and you have poor vision in your other eye, then you may need to make some changes or use low vision aids. These can help you make the most of your remaining sight. This may mean making things bigger, using brighter lighting, or using colour to make things easier to see.

If seeing detail with glasses or contact lenses is difficult, a low vision assessment can help you make the most of your vision. You can ask your ophthalmologist, optometrist or GP about having a low vision assessment. During this assessment, a low vision practitioner can explore equipment, aids or techniques that can help you make the most of your vision. This might be with magnifying aids, using lighting in the right way, or using contrasting colours to help make things easier to see.

You can also find tips for making the most of your sight by downloading our booklet: