What is central serous chorioretinopathy?
Central serous chorioretinopathy, often shortened to CSCR, is a condition in which fluid collects beneath the retina, usually under the macula. The macula is the part of the retina responsible for clear, detailed central vision.
The fluid causes the retina to lift slightly, which can lead to blurred, dimmed or distorted vision. Some patients notice a grey patch, altered colour perception or the sense that objects appear smaller or further away than normal.
CSCR most commonly affects adults in early to mid-life. It is associated with several factors, including psychological or physical stress, corticosteroid medication and sleep disturbance.
What symptoms can CSCR cause?
Symptoms may include:
- Blurred central vision
- Distorted vision, including straight lines appearing bent or wavy
- A grey or darker patch in the centre of vision
- Reduced contrast or difficulty seeing fine detail
- Colours appearing faded or altered
- Objects appearing smaller or further away
- Difficulty reading
- Increased sensitivity to bright light or glare
Symptoms range from subtle to intrusive. CSCR often affects one eye, although both eyes can be involved.
What causes CSCR?
The precise cause is not always clear. CSCR involves changes in the choroid, the layer of blood vessels beneath the retina.
Fluid passes through an area of weakness in the retinal pigment epithelium, the protective cell layer supporting the retina, and collects underneath the light-sensitive retina.
Factors associated with CSCR include:
- Psychological or physical stress
- Corticosteroid medicines, including tablets, inhalers, nasal sprays, creams and injections
- Disturbed sleep or obstructive sleep apnoea
- High blood pressure
- Certain hormonal or systemic health conditions
Patients should not stop prescribed corticosteroid medication without first speaking to the clinician who prescribed it. A specialist retinal consultation can review relevant risk factors and help coordinate any appropriate medication or wider health review.
How is CSCR diagnosed?
At The Retina Clinic London, CSCR is diagnosed through consultant-led retinal examination and advanced imaging.
Investigations may include:
- Optical coherence tomography, known as OCT, to show and measure fluid beneath the retina
- Fundus autofluorescence to assess changes in the retinal pigment epithelium
- Fluorescein angiography to identify areas of retinal leakage
- Indocyanine green angiography, known as ICG, to examine the deeper choroidal circulation
- OCT angiography to assess retinal and choroidal blood flow and identify abnormal blood vessels where relevant
- Review of corticosteroid use, sleep, blood pressure and other associated health factors
Together, these investigations confirm the pattern and activity of CSCR, guide monitoring and help distinguish it from other macular conditions, including wet age-related macular degeneration and inflammatory retinal disease.
Does CSCR need treatment?
Many first episodes of CSCR improve as the fluid resolves naturally. In these cases, careful observation with repeat OCT imaging may be the most appropriate approach.
Persistent, recurrent or visually significant CSCR may require active treatment to reduce ongoing fluid and limit the risk of longer-term retinal changes.
The management plan is based on:
- How long the fluid has been present
- Whether the condition has occurred before
- The position and pattern of leakage
- The degree to which vision is affected
- Changes in the retinal pigment epithelium
- The health of both eyes
- Relevant medicines and wider health factors
Close follow-up allows the response to be measured and the treatment plan to be adjusted when necessary.
What treatments are available?
Treatment is tailored to the imaging findings, the duration of the condition and its effect on vision.
Options may include:
- Careful observation with repeat retinal imaging
- Review of corticosteroid medication with the prescribing clinician
- Management of associated factors such as sleep disturbance, stress and high blood pressure
- Focal retinal laser for selected leakage points located safely away from the centre of the macula
- Photodynamic therapy using verteporfin and precisely targeted laser light
- Anti-VEGF injections in selected cases
The Retina Clinic London has access to photodynamic therapy with verteporfin for patients in whom this treatment is clinically appropriate.
Photodynamic therapy is an established option for selected cases of persistent or recurrent CSCR. Verteporfin is administered before targeted laser light is directed at the affected area of the choroid. Fluorescein and indocyanine green angiography help the consultant plan and target the treatment area precisely.
Anti-VEGF injections may also be considered in selected cases, particularly where imaging identifies associated abnormal blood vessel growth or another feature likely to respond to this treatment.
The consultant will explain the expected benefits, limitations and potential risks of each option before treatment is considered.
Our approach
The Retina Clinic London provides consultant-led assessment and treatment for central serous chorioretinopathy.
Our approach combines high-resolution OCT, ultra-widefield fluorescein angiography, indocyanine green angiography and other advanced imaging to identify the source and pattern of fluid and determine how the retina and choroid are affected.
We provide close imaging follow-up, review relevant medicines and systemic factors, and develop a personalised management plan based on the activity and duration of the condition.
Where treatment is appropriate, patients have access to focal retinal laser, anti-VEGF injections and photodynamic therapy with verteporfin at our clinic.
The aim is to establish a clear diagnosis, avoid unnecessary intervention when observation is appropriate and provide targeted treatment when CSCR is persistent, recurrent or affecting vision.
The next step
If you have blurred or distorted central vision, or have been told that you may have CSCR, a specialist retinal assessment can confirm the cause and guide the appropriate monitoring or treatment pathway.
To book your consultation, please call us on +44 (0)20 4548 5310 or visit https://www.theretinacliniclondon.com/book-a-consultation/
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