Central Serous Chorioretinopathy

Central serous chorioretinopathy is a condition in which "blisters" of fluid collect under the retina, or under the tissue that nourishes the retina, the retinal pigment epithelium (RPE).

 

Demographics

This condition typically occurs in younger adults between the ages of 30 and 50, although there have been many reported cases in older individuals. It is also more common in men, affecting approximately 3 times as many males as females. Central serous chorioretinopathy is often thought to result from stress, and many affected individuals are labeled as "type A" personalities. Other associations include pregnancy, renal disease, and steroid use.

Clinical Appearance & Symptoms

Central serous chorioretinopathy is often suspected when an individual presents with "blisters" of fluid under the retina or RPE (Figure 1). The patient often reports central blurring of vision, distortion, and micropsia (objects appearing smaller). There is often a shift in focus toward farsightedness.

Diagnosis

When central serous chorioretinopathy is suspected, certain diagnostic tests may be requested by your retinal specialist. The purpose of these tests is to confirm the diagnosis, evaluate the source of leakage of fluid, quantify the amount of fluid, and possibly guide treatment.

Fluorescein angiography may be employed in the diagnosis of central serous chorioretinopathy. In this procedure, a dye is injected into an arm vein and travels through the circulatory system to the eye. The dye acts as a tracer and is photographed as it passes through the ocular circulation. "Hot spots" of leakage can often be identified as the source of fluid causing the condition (Figure 2, 3, 4). If treatment (such as laser) is recommended, the angiogram is often used to guide treatment of these "hot spots."
Optical coherence tomography (OCT) is commonly used to obtain a high-resolution image of the retina, RPE, and fluid accumulations from central serous chorioretinopathy (Figure 5, 6). This technique is very valuable in quantifying the amount and location of fluid collections as well as following its resolution during healing or after treatment.

Treatment

Most cases of central serous chorioretinopathy resolve without treatment after several weeks or months. In certain circumstances, treatment is recommended. These include non-resolving fluid, a need for more rapid visual recovery, and a poor outcome in the other eye without treatment. When treatment is indicated, a laser is often used to "seal" an area of leakage identified on the angiogram. Thermal laser can not be used if the "hot spot" is directly in the center of vision, as the laser burn will damage the fine central vision. In these cases, a technique called photodynamic therapy may be recommended (see procedures). This involves an off-label use of a current macular degeneration treatment. A photosensitizing dye in injected intravenously and activated in the eye with a low energy (non-thermal) laser, resulting in no burn.

The prognosis with central serous chorioretinopathy is considered excellent, although there are certainly severe cases that result in significant, permanent visual loss in one or both eyes.

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