Central Serous Retinopathy
Central serous retinopathy (CSR), also known as Central Serous ChorioRetinopathy (CSCR), is a condition that leads to the accumulation of fluid under the retina, and usually affects the central part of the retina known as the macula.
CSR often presents with the sudden onset of a blurry fixed patch in the central vision of one eye. There may be associated distortion of straight lines. Patients sometimes describe a grey spot near the centre of their vision, which can be associated with a bright outline.
Who is affected?
CSR typically affects males more than females. The usual age of diagnosis is between 20-40 years old, although it can occur at any age. CSR typically presents as blurry central vision, that may be associated with visual distortion. Straight lines may appear kinked, bent or wavy. There may be a grey spot near the central vision, sometimes associated with a bright outline.
What causes CSR?
While the cause of CSR is not known, a number of factors can exacerbate the condition. Corticosteroid use is known to prolong episodes of CSR. This may be in the form of tablets such as prednisone, some asthma inhalers (eg Pulmicort), nasal sprays (eg Nasonex) or topical skin creams (for eczema and dermatitis eg. elocon, diprosone ).
Where possible it is preferable these medications be discontinued during an episode of CSR, but this must be done in consultation with your GP and/or treating physician after weighing up the risks and benefits.
There is some evidence that CSR can be exacerbated by periods of stress and people with type A personalities ("high achievers") may be more predisposed.
How is CSR Diagnosed?
CSR is diagnosed based on the clinical examination as well as characteristic findings on OCT scanning, as shown on the right. Some patients may need investigation with retinal angiography (FFA and/or ICG) to exclude underlying choroidal neovascularisation (CNV)
Management of CSR
Most cases of CSR resolve without treatment, usually within 6 months of onset. During this period it is important that the vision and fluid be monitored with regular checks. Where possible, try to reduce stressors in your life activities. In consultation with your GP and medical team, try to avoid corticosteroid use.
If the CSR does not resolve within 6 months, it is termed “chronic CSR” and requires medical intervention. This is because the risks of visual impairment from persisting subretinal fluid become more significant.
The appropriate treatment is based on the leakage point, as shown by Fundus Fluorescein Angiography (FFA) and ICG Angiography. Our clinic is equipped with ultra-wide field FFA and ICG imaging, allowing both angiograms to be performed within a short period of time using interweaved technology. ICG imaging allows visualisation of the deeper choroidal circulation, which can more clearly delineate the source of leakage. This specialised test is only available at a limited number of ophthalmology centres.
There is no single treatment option suitable for all cases of CSR, and treatment is usually guided by the location of the leakage point. There are risks and benefits with every treatment option that needs to be considered.
If the leakage point is away from the central vision, retinal laser may be appropriate. Half-fluence photodynamic therapy (PDT) has been shown to be effective for the treatment of CSR, and this may be more appropriate if the leakage point is closer to the central vision. Micropulse laser is another option in this situation.
There is developing evidence for medical therapy such as with spironolactone tablets, which may be suitable for some patients. There have been case series reporting the benefit of intravitreal injection therapy for some patients.
Our retinal specialists will discuss the various treatment modalities with you in further detail should this be required. A patient information pamphlet from the American Society of Retinal Specialists (ASRS) can be downloaded below.