Central serous retinopathy

Central serous retinopathy (CSR), also known as central serous chorioretinopathy (CSCR), is an eye condition that affects the macula, part of the retina at the back of the eye. It usually affects one eye (but can affect both) and is more likely to affect men than women. It's most common among men aged between 20 and 50 (Source: Macular Society).

CSR is an eye condition in which fluid collects behind the retina at the back of the eye. As fluid builds beneath the macula at the centre of the retina, it can cause blurred and distorted vision.

The cause of CSR often isn't known, but there are risk factors such as stress and the use of corticosteroids that can be managed.

Getting a central serous retinopathy diagnosis

CSR can be diagnosed with a scan called optical coherence tomography (OCT). This uses a special camera to take detailed images of the retina. Having an OCT is generally quick and straightforward. 

Some people may also have a diagnostic test in which coloured dye is injected into the arm. The dye travels through the body and can be seen in the blood vessels in the retina by a special camera. This is a fundus fluorescein angiography (FFA), and it can help plan your treatment.

CSR affects central vision and can cause blurred and distorted vision, cause objects to look smaller than they are, and affect how you see colours. Some people don't have obvious symptoms. Reassuringly, for most people, the condition gets better without treatment and without a lasting impact on their vision. When CSR lasts longer than a couple of months, treatment may be necessary. 

Central serous retinopathy symptoms and your vision

CSR occurs more often in one eye than in both. The kind of symptoms you might experience with CSR affect your central vision and include:

• Blurred or distorted vision
• Noticing that objects appear smaller than they are
• Colours appearing faded
• Difficulty seeing the difference between objects of similar colours
• Being more sensitive to bright light
• Having blind spots in your central vision

Symptoms can develop gradually or suddenly, but not everyone with CSR will experience noticeable symptoms. 

If you notice any changes to your sight, visit an optician. They can check for a wide range of eye conditions and refer you to an ophthalmologist (eye doctor) for follow-up if necessary.

CSR can resolve itself after a few months, and if it does, you're likely to find your vision improves. If CSR doesn't improve in this time, especially if you have it for 12 months or more (chronic central serous chorioretinopathy), there's a greater chance of lasting changes to your sight. 

For a small proportion of people with CSR, complications can develop. Some people get a growth of abnormal blood vessels in the membrane under the retina (choroidal neovascular-membrane) and will need anti-VEGF injections to treat it. CSR can also sometimes lead to problems with special cells that line the retina, called retinal pigment epithelial cells (RPE). This can permanently affect your vision. 

Causes of central serous retinopathy

Most of the time, the cause of a person's CSR isn't known. However, risk factors that we know can make it more likely include: 

• Corticosteroid use such as taking steroid medicines for medical conditions including asthma, hay fever, eczema and other conditions
• Experiencing high levels of stress, which increases cortisol in the body (such as going through a challenging life event) or having a highly driven, competitive personality (sometimes known as a type A personality) 
• Having Cushing syndrome, a condition that increases the amount of natural steroids in the body
• Pregnancy 
• Night shift work 

Central serous retinopathy treatment

Most people won't need treatment for CSR. The affected eye may heal by itself over a few months without permanent vision change. 

If your condition doesn't improve - within four to six months - your ophthalmologist may recommend treatment options such as:

• Thermal laser treatment - a laser is used to seal the fluid leakage. This treatment depends on the exact location of the leak. It can't be used too close to the macula because it can damage it. 
• Photodynamic therapy (PDT) - using a low-energy (instead of thermal) laser with a light-sensitive drug injected into the bloodstream.

Your eye specialist might also talk to you about changes that may help reduce risk factors, such as reviewing the use of steroid medicines if possible and ways to limit your stress levels.  

When to get medical advice

The NHS recommends having regular eye tests every two years. This can help identify many eye conditions in the early stages, often before you even notice symptoms. 

If you do notice any changes to your sight, see your optician or GP for a check-up. They'll be able to refer you if you need more specialist support. 

Living with central serous retinopathy

It's normal to feel worried if you've been diagnosed with an eye condition that's affecting your sight. Especially if there's a chance your eyesight won't recover and be as good as it was before. It can help to hear from other people living with the condition. There is a lot of support available to help you with the emotional and practical aspects of living with an eye condition.

Frequently asked questions