What is Central Serous Retinopathy ?
Central serous retinopathy (CSR) is an uncommon disorder of the retina. In its simplest form CSR is a condition where one or more parts of the macula develop fluid blisters. The fluid blisters can affect the retina itself in which case the fluid is termed sub retinal (SRF). Alternatively the fluid can develop in a deeper part of the retina producing a blister called a pigment epithelial detachment (PED).
“CSR is a highly variable, enigmatic condition and is occasionally mistaken for wet macular degeneration and vice versa. Expert evaluation is essential to confirm the diagnosis of CSR especially in atypical cases”.
CSR is thought to be a condition that arises without any clear underlying reason in the majority of cases. The major clinical description of CSR has been known for many years but it remains a somewhat mysterious, enigmatic and highly variable condition.
The most common symptoms are as follows ;
- Blurred vision
- Distorted vision
- Objects seeming smaller than in the other eye (micropsia)
- Dark spot like vision disturbance (often described like an oil spot)
- Who is at risk of CSR ?
CSR typically affects men more often than women and the usual age range of 20-50 has been reported. However our own experience of CSR is that there are patients who can develop CSR significantly outside this age range too. In cases where patients are over 55 years of age CSR can overlap with wet macular degeneration making a firm diagnosis often very challenging. We have witnessed several cases of CSR being diagnosed as wet AMD with resultant eye injections being administered sometimes for many months before the diagnosis of CSR has been entertained.
Certain personality types appear to have a greater likelihood of acquiring CSR in their lifetime. We often see CSR diagnosed amongst intelligent, high achieving people. There may also be a link with acute and chronic stress.
Another common link with CSR is previous or current medical treatment with a class of drug known as corticosteroids. Corticosteroids are one of the most widely used medical treatments and our own experience has been that some cases of CSR are very closely linked with steroid use. Corticosteroids may be being used for treating asthma, hayfever even eczema and ear infection related cases of CSR have been seen in our clinics.
- Prognosis and Course of CSR
The good news is that in perhaps upto 80% of cases – the condition is self limiting. What this means is that over a period of 3-6 months CSR often gets better. As the condition improves so the visual symptoms tend to improve too.
Unfortunately in some patients each episode of CSR may leave a tiny area of damage in the macula and so there is a risk of some slight vision impairment remaining even after full resolution of the condition. In situations where a individual develops only one or two episodes of CSR in a lifetime then the degree of vision impairment is likely to be very small. However frequent episodes of CSR can result in accumulated damage to the macula with significant impairment of vision in rare cases.
- Example case study
In the case below two OCT scan images (optical coherence scan) show a gradual resolution of CSR over time. The patient was a 52 year old women who made a full, natural recovery from CSR with no further episodes to date.
The lower scan shows a PED (pigment epithelial detachment) blister with clear resolution over several months as shown in the top scan.