Retinal - Macular Disorders

Central Serous Retinopathy

by Scott Pautler, MD

What is central serous retinopathy (CSR)?
CSR is an abnormal leakage of clear fluid under the retina, which causes symptoms of blurred vision often associated with a round or oval dark spot in the central vision. The retina is a thin layer of delicate tissue in the back of your eye, which lines the inside wall like the film in a camera. The retina “takes the picture” of objects you look at and sends the message to the brain.

What causes CSR?
The exact cause of CSR is unknown. It usually occurs in middle-aged individuals who have a type-A personality and who are often under stress at home or work. Individuals with type-A personality are perfectionists who often feel pressured by time constraints. Research suggests that hormones released under stress can affect the flow in the blood vessels beneath the retina. These vessels may leak an abnormal amount of fluid, which then works its way under the center of the retina. Rarely, medical conditions (Cushing’s Syndrome), medications (pseudoephedrine, steroids like prednisone, cold medication, diet pills, and medications for erectile dysfunction), and other agents (testosterone, cocaine, caffeine, amphetamines, etc.) may contribute to the development of CSR.

What is the treatment of CSR?
In many cases, the symptoms will disappear with time alone. In other situations treatment with laser or injections may help to recover vision. Treatment is performed in the office without pain. Side effects are rare, but may include the appearance of a small, permanent blind spot in the vision. The doctor can recommend the best course of action by taking special pictures of the eye called a fluorescein angiogram. The fluorescein angiogram shows where the leak is coming from, how active the leak is, and whether laser might be helpful. There is no good evidence to suggest that a change in lifestyle (e.g. change of career) would be of benefit. Patients with high blood pressure may benefit from beta-blocker medications.

What will happen to my vision?
Usually the vision returns to normal or near normal. Rarely, the problem will cause permanently limited central vision. In about a third of cases, CSR will return at a later date in the same or other eye. Therefore, any future decrease in vision should be reported to the doctor.