Central Serous Retinopathy: What It Is, Causes

What It Is, Causes, Signs and Symptoms, and More

Author: Ashley Mauldin, MSN, APRN, FNP-BC, CNE

Editor: Alyssa Haag, MD

Editor: Emily Miao, MD, PharmD

Editor: Kelsey LaFayette, DNP, ARNP, FNP-C

Illustrator: Abbey Richard, MSc

Modified: May 28, 2024

What is central serous retinopathy?

Central serous retinopathy (CSR), also known as central serous chorioretinopathy (CSCR), is a common condition characterized by increased fluid under the retina of the eye. The eye consists of three layers: the outermost layer known as the sclera, followed by the middle layer, or the choroid, and finally, the innermost layer, or the retina. The retina is responsible for relaying information from the environment to the brain to create images. With central serous retinopathy, the increased fluid originates from a leak in the retinal pigment epithelium (RPE), or more specifically, the choroid, and can result in vision loss, blurring of central vision, and serous retinal detachment, which is when the retina detaches due to fluid accumulation.

CSR usually affects only one eye, but it can affect both in some cases. CSR commonly occurs in middle-aged individuals assigned male at birth. CSR has also been shown to be present in individuals who have increased stress in their lives, like with some type A personalities, or those who have behaviors associated with high achievement, competitiveness, and rigid organization.

What causes central serous retinopathy?

The exact cause of CSR is unknown, however, CSR is thought to be caused by fragmentation (i.e., defect) of the retinal pigment epithelium (RPE). The RPE is a layer of tissue that separates the retina and the choroid. With CSR, extra fluid puts pressure on the RPE and can cause a serous detachment of the retina from the choroid.

Risk factors for central serous chorioretinopathy include high blood pressure; hormone changes, like increased progesterone during pregnancy that can cause increased circulating blood volume; and sleep disorders, like sleep apnea where increased levels of epinephrine and norepinephrine can cause changes to retinal and choroidal blood flow. Additionally, there is an increased risk of CSR worsening with the use of corticosteroids (e.g., fluticasone or hydrocortisone) and some chemotherapy agents (e.g., trastuzumab, MEK inhibitors).

What are the signs and symptoms of central serous retinopathy?

Signs and symptoms of CSR can include changes in vision, such as blurred or decreased vision; dark spots in one’s visual field; objects appearing distorted or further away; and lines appearing bent. In some cases, CSR can cause complete vision loss.

How is central serous retinopathy diagnosed?

CSR can be diagnosed through a dilated eye exam, where any changes to the retina can be visualized. An optical coherence tomography (OCT) scan can also be used to diagnose CSR. An OCT scan helps the healthcare provider visualize the retina in great detail which allows for the detection of the pockets of fluid associated with CSR. Additionally, fundus fluorescein angiography can also be used to diagnose CSR. Dye is injected through a peripheral intravenous catheter, and pictures are taken to determine if there is any fluid leakage underneath the retina. Lastly, indocyanine green angiography (ICGA) can be helpful in determining if there are any changes present in the choroid vasculature. In ICGA, indocyanine green dye along with infra-red light are used to visualize the deep retinal layers.

How is central serous retinopathy treated?

CSR usually resolves on its own over three to six months, however, there are several treatment options if the condition persists. Treatment for central serous retinopathy can include therapies like thermal laser treatments, also known as thermal laser photocoagulation, where a laser is used to shrink or destroy any areas of leakage; photodynamic therapy (PDT), where a light source is used to remove abnormal cells; and intravitreal medications consisting of anti-vascular growth factors (anti-VEGF), like ranibizumab and bevacizumab. Oral medications including mineralocorticoids (e.g., spironolactone) and NSAID eye drops (e.g., diclofenac) can also be recommended to help treat vision loss and restore vision.

If an individual is taking a corticosteroid, this medication should be discontinued immediately to prevent the worsening of CSR. Long-term persistent CSR can cause irreversible visual decline so some healthcare providers choose to initiate treatment earlier.

What are the most important facts to know about central serous retinopathy?

Central serous retinopathy (CSR), also known as central serous chorioretinopathy (CSCR), is a common condition characterized by increased fluid under the retina of the eye. This increased fluid originates from a leak in the choroid and can result in vision loss, serous retinal detachment, and blurring of central vision. The exact cause of CSR is unknown, however, CSR is thought to be caused by the fragmentation, or defect, of the retinal pigment epithelium (RPE). Signs and symptoms of CSR can include changes in vision, such as blurred or decreased vision; dark spots in vision; objects appearing distorted or further away; and lines appearing bent. CSR can be diagnosed through a dilated eye exam, optical coherence tomography, fundus fluorescein angiography, and indocyanine green angiography. CSR usually resolves on its own over 3 to 6 months, however, there are several treatment options if the condition becomes chronic. Treatment for central serous retinopathy can include therapies like laser treatments, also known as thermal laser photocoagulation; photodynamic therapy (PDT); and anti-vascular growth factor (anti-VEGF).

Bahadorani S, MacLean K, Wannamaker K, et al. Treatment of central serous chorioretinopathy with topical NSAIDs. Clinical Ophthalmology. 2019;Volume 13:1543-1548. doi:https://doi.org/10.2147/opth.s202047

Central Serous Chorioretinopathy. The American Society of Retina Specialists. www.asrs.org. https://www.asrs.org/patients/retinal-diseases/21/central-serous-chorioretinopathy

Indocyanine Green Angiography. Department of Ophthalmology and Visual Sciences. medicine.uiowa.edu. https://medicine.uiowa.edu/eye/patient-care/imaging-services/indocyanine-green-angiography

Leveque TK, Yu L, Musch DC, Chervin RD, Zacks DN. Central serous chorioretinopathy and risk for obstructive sleep apnea. Sleep Breath. 2007;11(4):253-257. doi:10.1007/s11325-007-0112-3

Olusanya BA, Oluleye TS. Unilateral central serous chorioretinopathy in a pregnant Nigerian woman. Niger Med J. 2015;56(5):372-374. doi:10.4103/0300-1652.170380

What is Central Serous Chorioretinopathy? American Academy of Ophthalmology. Published September 21, 2022. Accessed November 9, 2023. https://www.aao.org/eye-health/diseases/what-is-central-serous-retinopathy#:~:text=Central%20serous%20chorioretinopathy%20treatment&text=In%20these%20cases%2C%20laser%20treatment

Central Serous Retinopathy

What It Is, Causes, Signs and Symptoms, and More

What is central serous retinopathy?

What causes central serous retinopathy?

What are the signs and symptoms of central serous retinopathy?

How is central serous retinopathy diagnosed?

How is central serous retinopathy treated?

What are the most important facts to know about central serous retinopathy?

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