central serous chorioretinopathy

What is central serous chorioretinopathy?
Central serous chorioretinopathy (CSCR), sometimes called central serous retinopathy or choroidopathy, is a condition in which fluid builds up under the retina, almost like a blister.  This causes a serous detachment of the neurosensory retina, which results in sudden blur and distortion of central vision, usually in one eye only.

Retinal photo of a patient with CSCR (see the bubble in the center?)

Who gets CSCR?
CSCR is more common in males, usually between the ages of 20 and 50.  The exact cause is unknown, but stress and steroid use are risk factors (1).  

How is it diagnosed?
The patient's symptoms and the clinical appearance on dilated examination is usually sufficient to make a diagnosis of CSCR.  A couple of additional tests may be used to confirm the diagnosis and monitor resolution:

• Optical Coherence Tomography (OCT)- A scanning laser creates a cross-sectional image of the layers of the retina and allows eye doctors to measure the thickness of the retina.  Below is the macula OCT of the same patient whose retina is in the photo above.

Macula OCT of the same CSCR patient

• Fluorescein angiography (FA)- Fluorescein dye is injected into a vein in the arm, and photos of the retina are taken as the dye travels through to the vessels of the retina, highlighting areas of leakage.

What is the treatment?

Most cases of CSCR resolve on their own within 3 or 4 months, so observation is most appropriate. In cases where visual recovery is urgent, or the CSCR does not resolve on its own after a few months (which can be up to 20% of cases 2), intervention may be indicated. These cases may be treated with laser, though the end result with and without treatment has been found to be similar. There are many investigational treatments involving the use of oral medications (most recently, eplerenone) or anti-VEGF injections, but nothing definitive has been concluded based on the studies.  In up to half of CSCR cases, the condition recurs (3).   

CliffsNotes: Central serous chorioretinopathy is a blister-like fluid accumulation under the retina. It blurs and distorts central vision, but usually resolves on its own in a few months.