Central Serous Retinopathy

Central Serous (Chorio) Retinopathy

CSR- there is a pale area surrounding the fovea (the red dot near the centre of the image)

Also called central serous choroidopathy, this condition arises because of a leakage from the blood vessels in the choroid, the layer beneath the retina. The fluid causes a serous detachment of the retina at the posterior pole (the back of the eye) where the fluid accumulation under the retina lifts it up and away from the retinal pigment epithelium. This condition is more common in males that females, and is most common at around age 45. There is an association with stress- generally this condition is most common in high achievers/ go getters. There may be an increased risk in those on steroid therapy, say for auto-immune disease.

Symptoms include blurred vision, and perhaps a blind spot in, or dullness of straight ahead of vision. There may be distortion of straight lines in the affected eye, and objects may appear to be smaller and/or further away.

Investigation involves examining the eye, where the retina can usually be seen to be raised, when it should not be.

Referral for further investigation would generally result in a fluorescein angiogram being performed- fluorescein (a fluorescent dye) is injected in the arm and photographs taken of the interior of the eye. The resulting images show a classic “smoke stack” leakage of fluorescein from the blood vessels into the fluid space beneath the retina. Normally there would be no such leakage of the dye- it would arrive at the eye in the arteries, go through the capillaries and leave through the veins without leaving any residual fluorescence. OCT Ocular Coherence Tomography can also be used to measure and map the thickness of the retina- allowing a cross section of the tissue to be imaged.

Usually this condition can last 1 to 2 months, and often resolves without treatment. There would often be a slight deterioration in the vision in that eye after resolution, but usually slight. Rarely there can be scar formation at the posterior pole, which can cause permanent impairment of the central vision in the affected eye.

If the individual was on steroid treatment, then stopping treatment would be considered, if possible. Sometimes the condition may persist, and then there may be attempts to treat using laser to seal the leaky vessel, or a lower powered laser with photosensitising drugs – treatment called PhotoDynamic Therapy allows the leaky vessels to be targeted with less risk of damaging the healthy surrounding retina.

Central Serous Retinopathy can recur in about 50% of those affected- the prognosis for visual improvement doesn’t diminish with repeated bouts, but there may be a subtle deterioration every time it has resolved. Treatment would be considered if there was recurrence.

Although this condition is usually self limiting – often the decision is taken not to treat, but just to monitor, it should still be investigated promptly as should any distortion or disturbance of vision- some other causes DO require urgent treatment.

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