Central Serous Retinopathy

What is Central Serous Retinopathy (CSR)? 

CSR is a condition in which fluid collects underneath the retina at the back of the eye. This results in an elevation of the retina, which affects the vision. Patients often notice a circular grey patch in their vision. They may also notice distortion and that objects appear smaller in the affected eye. 

Illustration: compare the normal retina OCT in the first picture with the CSR-affected retina in the second picture. Notice the black ‘blister of fluid’ in the patient with CSR (second picture).

What causes it? 

CSR can occur in almost anybody, however it is most common in middle-aged men. The cause is idiopathic (that is, it’s not known). It tends to occur in people who are highly driven, work long hours, or have high levels of stress for any reason. Such patients have often been identified as having a ‘Type A personality’. 

Curiously, CSR is also more common in people taking steroid medications (such as steroid tablets, puffers or following joint injections).

Is it curable? 

The good news about CSR is that it tends to get better on its own over several months. As such treatment is generally not initially recommended. If it doesn’t resolve, Dr Johnson may suggest treatment with a retinal laser. There are risks and benefits though, and he will discuss these with you if treatment is considered.

What is the treatment? 

As mentioned above, most of the time CSR doesn’t need treatment as it gets better on its own. However, if necessary a laser may be used to seal the area of leakage.

Laser is only usually effective if a focal area of fluid leakage is detected on a fluorescein angiogram. If the leakage is too close to the central part of the vision, or if the area is very large, then laser may not be possible. There are several different types of laser that can be used, but there isn't a big difference between which technique is the best.

Fig A: A retinal photo of CSR 

Fig B: Fluorescein angiogram

Fig C: (Immediately after laser):

Fig D: (3 months after treatment)

Illustration: This is an example of a patient with CSR (fig A). After 3 months of reduced vision, a fluorescein angiogram (fig B) was performed which confirmed a small area of leakage that was amenable to laser treatment (fig C). 3 months after treatment (fig D), the fluid has resolved, and the patient has no symptoms.

Remember that CSR most commonly (not always) affects people that have too much stress in their life. It is recommended that you identify the factors causing stress and try to minimise them if possible. Speaking with your GP about such strategies can be very helpful. Such strategies should start without the use of medication (if at all possible). Many people recommend using several different forms of relaxation techniques, modifying work practices and other techniques to reduce stress levels. 

Sometimes reducing or stopping steroid use will allow the CSR to resolve. Please speak with your physician regarding reducing your steroid intake. If you are taking steroids, never stop steroids abruptly without your prescribing doctor’s advice.

Dr Joshua Yuen

Dr Joshua is an experienced consultant ophthalmic surgeon, who specialises in retinal diseases and cataract surgery... read more

Dr Brad Johnson

Dr Johnson is an experienced consultant ophthalmic surgeon, who specialises in retinal diseases and cataract surgery... read more