Introduction  

The causes of CSRC are unknown. However, corticosteroid drugs can bring about or worsen CSRC, for instance, allergy nose sprays and anti-inflammatory skin creams. They are readily available over the counter. The disease could also be genetic. The following are the risk factors associated with CSRC:

  • Men between the age of 20 and 50 are more likely to develop CSRC than women. However, the disease can affect anyone
  • People dealing with a lot of stress
  • Hypertension or high blood pressure
  • Steroids whether taken orally, through inhalation or intravenous means
  • Insomnia (difficulty falling asleep)
  • An infection of Helicobacter pylori (a type of bacteria that infects the stomach)
  • People with Type A behavior (competitive, aggressive behavior)
  • Autoimmune diseases (they result from the body attacking its own tissues)
  • Current or recently pregnant women 
  • Other drugs like decongestants, stimulants, anti-cancer medications and erectile dysfunction drugs
     

Also Known As

Central Serous Retinopathy
CSR

Sub-Types

Central serous chorioretinopathy refers to the build-up of fluid in the retina. The retina is the layer of nerve cells lining the back part of the inner eye. The fluid leaks from the choroid, the part of the eye between the sclera and retina which contains blood vessels and connective tissue. 

Another source of fluid leakage is the retinal pigment epithelium (RPE). RPE is a layer of cells whose failure to work leads to fluid build up under it. This action may result in a small detachment beneath the retina that may distort vision. CSRC commonly affects one eye although it's possible for both eyes to be affected at the same time.

Causes and Risk Factors

The causes of CSRC are unknown. However, corticosteroid drugs can bring about or worsen CSRC, for instance, allergy nose sprays and anti-inflammatory skin creams. They are readily available over the counter. The disease could also be genetic. The following are the risk factors associated with CSRC:

  • Men between the age of 20 and 50 are more likely to develop CSRC than women. However, the disease can affect anyone
  • People dealing with a lot of stress
  • Hypertension or high blood pressure
  • Steroids whether taken orally, through inhalation or intravenous means
  • Insomnia (difficulty falling asleep)
  • An infection of Helicobacter pylori (a type of bacteria that infects the stomach)
  • People with Type A behavior (competitive, aggressive behavior)
  • Autoimmune diseases (they result from the body attacking its own tissues
  • Current or recently pregnant women 
  • Other drugs like decongestants, stimulants, anti-cancer medications and erectile dysfunction drugs
     

Signs & Symptoms

CSRC may present the following symptoms:

  • Blurred, dimmed or distorted center of vision
  • Seeing straight lines as irregular, crooked or bent
  • A dark area in the central vision
  • White objects seem brownish or acquire a dull color
  • Objects seem smaller or farther away than they are
  • Reduced contrast sensitivity
  • Vision fluctuations
     

Diagnosis

The eye care professional will do the following to diagnose CSRC:

  • Dilate the eyes using dilating eye drops to look into the retina.
  • Take photographs of the eye by using fluorescein angiography. The doctor will inject a dye into the vein of an individual’s arm. He/she will then take pictures of the eye as the dye makes its way via retinal blood vessels. 
  • Use of optical coherence tomography (OCT) to examine the retina. This machine scans the back of the eye to provide detailed three-dimensional photos. OCT helps the eye care professional to measure the thickness of the retina. It also helps him/her to determine if the retina is swollen.

Treatment 

Treatment of CSRC is aimed at emptying the retina of the fluid that has collected there.

Medical Treatment

In most cases, CSRC will clear up in a month or two without any treatment. However, the eye care professional will frequently need to check that the fluid is clearing. Treatment is limited to patients who have persistent subretinal fluid for four to six months. Treatment is also considered in cases where there is recurrence from a previous case that led to a permanent visual loss. An intraocular injection of Avastin may be administered.

Surgical Treatment

In severe cases of CSRC where the leakage refuses to go away or there is severe vision loss, surgery will be done. The surgeon will use laser treatment or photodynamic therapy. In the latter treatment, the surgeon will inject Verteporfin into the patient’s arm. The drug may prevent future recurrences of CSRC. These treatments have the potential to seal the leak and restore vision.

Prognosis/Long-term outlook

Some people may have complications from laser treatment. Laser surgery may impair their center of vision.
Most cases of CSRC will go away without treatment within a month to six months. However, vision may not be restored to the initial condition before the attack. In some cases, CSRC may last up to one year with treatment. However, CSRC that lasts longer than 12 months may lead to retinal detachment. 
Patients should ensure they have regular follow-up examinations with the eye care professional. If the fluid is allowed to accumulate, it can lead to permanent loss of vision in the long-term.
Individuals with autoimmune conditions should consult their doctors about the possibility of stopping steroid drugs while having CSRC.
CSRC often recurs in about 50% of the patients. Nevertheless, the outlook is usually good. People will rarely develop permanent scars that damage their center of vision.

Prevention/Follow Up

Even though there is no known prevention for CSRC, the following may help:

  • Avoiding corticosteroid use
  • Reducing stress levels