Central Serous Chorioretinopathy (CSCR)

What happens in CSCR

The retina is the light-sensitive layer at the back of the eye. Beneath it lie the retinal pigment epithelium (RPE), a single layer of cells that acts as a pump and barrier, and the choroid, a dense layer of blood vessels. In CSCR, the choroidal vessels become congested and leaky (choroidal hyperpermeability), and fluid passes through weak spots in the RPE. The fluid collects under the macula as a small blister, a serous detachment, which blurs and distorts central vision.

CSCR belongs to the "pachychoroid" group of conditions, in which the choroid is unusually thick.

Symptoms

• blurred or dim central vision in one eye
• a gray, brown or darker spot in the center of vision
• straight lines looking bent or wavy (metamorphopsia)
• objects looking smaller in the affected eye (micropsia)
• colors looking washed out
• reduced contrast and slower adjustment from bright light
• sometimes a new farsightedness, so reading glasses no longer suit

It is usually painless and the eye looks normal. Peripheral vision is not affected.

Causes and risk factors

• Corticosteroids: the strongest modifiable risk factor. All forms count: tablets, injections, inhalers, nasal sprays, skin creams, eye drops and joint injections.
• High natural cortisol: Cushing syndrome.
• Stress and "type A" personality.
• Male sex: men are affected roughly 6 times more often than women.
• Age 30 to 50.
• Pregnancy, especially the third trimester.
• Obstructive sleep apnea.
• Stimulants and some medicines: including some decongestants, sildenafil and certain cancer drugs (MEK inhibitors cause a similar picture).
• H. pylori infection and high blood pressure have also been linked.

Types

Diagnosis

An eye doctor (ophthalmologist or optometrist) will check your vision and examine the retina after dilating the pupils. Key tests:

• Optical coherence tomography (OCT): a quick, painless scan showing fluid under the retina and the thickness of the choroid. It is the main test for diagnosis and follow-up.
• Fluorescein angiography: dye injected into an arm vein highlights the leak point, often as an "ink blot" or "smokestack" pattern.
• Indocyanine green angiography: shows choroidal congestion and helps guide photodynamic therapy.
• Amsler grid: a grid of lines to detect distortion at home.

Doctors also rule out conditions that look similar, such as wet macular degeneration, macular edema and retinal detachment.

Treatment

Observation and removing triggers

For a first episode, most eye specialists observe for about 3 months, because the fluid usually resolves on its own.

• Steroids: tell all your doctors about the CSCR. Steroids should be reduced or stopped if medically safe. Never stop steroid tablets suddenly without medical advice.
• Stress reduction and good sleep.
• Treat sleep apnea if present.
• Avoid stimulants where possible.

Treatments for persistent or chronic CSCR

• Half-dose or half-fluence photodynamic therapy (PDT): a light-activated medicine (verteporfin) and a low-energy laser that reduces choroidal leakage. It is the most effective treatment for chronic CSCR.
• Micropulse laser: a subthreshold laser that may reduce fluid without damaging the retina.
• Focal thermal laser: for a single leak away from the center of the macula.
• Mineralocorticoid antagonists (eplerenone, spironolactone): previously popular, but a large randomized trial found eplerenone did not improve vision in chronic CSCR, so they are now used less.
• Anti-VEGF injections: if abnormal new blood vessels develop.

Outlook

Most people with acute CSCR regain good vision within months, though subtle changes in contrast or color can remain. About a third to half have a recurrence within a year. Chronic CSCR can cause permanent central vision loss from RPE and photoreceptor damage, which is why persistent fluid is treated.

Frequently asked questions

What causes central serous chorioretinopathy?

CSCR is caused by fluid leaking from congested blood vessels in the choroid through the retinal pigment layer, collecting under the macula. The strongest risk factor is corticosteroid use in any form. Stress, male sex, age 30 to 50, pregnancy and sleep apnea also raise the risk.

Does central serous chorioretinopathy go away?

Usually, yes. About 80 to 90% of first episodes resolve within 3 to 4 months without treatment. Vision typically returns close to normal, though recurrences are common. Fluid that persists beyond a few months is often treated to protect vision.

Can steroids cause central serous retinopathy?

Yes. Corticosteroids are the most important known trigger, including tablets, injections, inhalers, nasal sprays, skin creams and eye drops. If you develop CSCR, ask your doctor whether the steroid can safely be reduced or stopped.

Is CSCR serious?

Acute CSCR is usually not serious and resolves on its own. Chronic or recurrent CSCR can cause permanent central vision loss. Regular follow-up with OCT scans and treatment of persistent fluid help prevent lasting damage.

Can stress cause central serous chorioretinopathy?

Stress is a well-recognized risk factor. Stress hormones, including cortisol and adrenaline, are thought to affect choroidal blood flow and leakage. Managing stress and improving sleep are part of the standard advice for people with CSCR.