Central Serous Chorioretinopathy

Central Serous Chorioretinopathy (CSCR) is a condition that affects the innermost layer of the eye responsible for sensing light and forming visual images. CSCR often affects the macula, which is region of the retina that is most important for central vision. CSCR occurs when fluid accumulates underneath the retina, forming a pocket of fluid similar to a blister. This can cause temporary or permanent damage to vision.

Central Serous Chorioretinopathy

OCT Scan of CSCR showing fluid under the retina

CSCR usually occurs in one eye, but occasionally can happen in both eyes. 
Symptoms of CSCR that you may notice include:

• Blurred central vision
• A patch of vision that is blurred or where colours seem different
• Distortion of vision (where straight lines become abnormally curved or "wavy")
• Difference in object or image size between the two eyes
  
  

CSCR may be linked to steroid use, which can include oral or intravenous steroids, as well as steroid creams, inhalers or sprays. In some patients there may be a history of traditional medication use. Generally, we advise that patients with CSCR stop such medications where possible, to prevent the condition from recurring. However, many patients also may not have any associated medication use that triggered the CSCR.

There is also a link to stress but this is often difficult to quantify or verify.

What causes CSCR?

It is not known exactly what causes CSCR, but the condition has been associated with stress, certain hormonal disruptions, and the use of steroid medications. Some traditional medicine and herbal medicine, has also been known to trigger or worsen the condition.

What puts me at risk of CSCR?

The risk factors of CSCR include:

• Gender: males are 5 to 10 times more likely to be affected
• Stress
• Steroid use – including oral or intravenous steroids, as well as steroid creams, inhalers or sprays
  
  

An eye examination by an eye doctor can accurately diagnose the problem. Usually this is done through a clinical examination and an optical coherence tomography (OCT) scan.

• Optical Coherence Tomography (OCT)
  OCT is similar to an ultrasound scan, except that the latter uses sound waves to capture images. OCT uses light waves instead, and can capture very detailed, cross-sectional images of the retina, which helps to diagnose and monitor cases of CSCR. OCT imaging is very fast and convenient. You will be asked to place your head on a chin rest and hold still for several seconds while the images are obtained. The light beam used is painless, and unlike X-rays, it does not involve any radiation.
  
  In certain cases, other tests such as dye-based angiography or OCT angiography (OCT-A) may be recommended by your eye doctor to assess the severity of your condition and formulate a treatment plan.
  
  

• Fundus Fluorescein Angiogram (FFA) and Indocyanine Green Angiogram (ICG)
  In this test, a fluorescent dye is injected into a vein in your arm. Over the next few minutes, photographs are taken of the blood vessels in your eye as the dye passes through. This helps to highlight areas of abnormal fluid leakage. Uncommonly, complications due to the dye injection can arise, such as nausea, or in very rare cases, severe allergic reactions or heart problems.
  
  
• Optical Coherence Tomography Angiography (OCT-A)
  In some cases, the blood vessels in the retina can be examined with OCT-A. Based on the same technology as OCT, OCT-A uses light waves to capture very detailed images of blood vessels in the eye. OCT-A does not require any fluorescent dye injection, and also does not involve any radiation.
  

In most cases, CSCR will resolve on its own over a period of weeks to months, especially if the underlying factors or medications causing the problem can be identified and stopped.

However, sometimes treatment may be offered if the problem continues, or re-occurs frequently. Current treatment options include photodynamic therapy (PDT), using a non-thermal "cold" laser together with an intravenous medication (verteporfin), or laser photocoagulation using with a thermal "hot" laser, to "seal" the leak and reduce fluid accumulation under the retina. Successful treatment does not guarantee that CSCR will not recur in the future in either eye.