Central Serous Retinopathy

What is Central Serous Retinopathy (CSR)?

The retina is a layer of special light sensitive tissue at the back of the eye that sends nerve impulses up the optic nerve to the brain. The macula is a very small area at the centre of the retina. It is the macula that is responsible for pinpoint vision, that allows you to read, or recognize a face.

In people with CSR, fluid leaks from the layer underneath the macula and lifts it off the wall of the eye, like a blister, called a ‘serous detachment’. This blister can cause distortion or blurry vision, a blind or gray spot in the central vision, and unexplained flashes of light. The leak can occasionally cause development of abnormal new blood vessels that leak blood, not just fluid.

Why did I get CSR?

The exact cause of CSR is not known. It has been associated with increased stress and steroid medications, or increased steroids being produced by your body. Patients with CSR tend to be far-sighted and they may have an unusually thick choroid (the layer surrounding the retina). It is not usually associated with other eye diseases.
If it has occurred in one eye, you are at higher risk of it occurring in the other eye.

Management for CSR

Fortunately, the recovery is quite good in the majority of cases of CSR. Identifying stressful aspects of your life and resolving them is an important part of the management. The vision of most patients improves spontaneously over a few months. There may be mild permanent visual changes such as decreased contrast, night vision or increased
distortion.

In some cases, new detachments may develop weeks, months, or even years later. Each episode can damage the retina over time. You may need further blood tests if the CSR does not resolve or recurs frequently.

If CSR is recurring frequently, further blood tests may be required. This will check whether your body has another underlying condition.

Fluorescein Angiogram

This is a test where a special dye is injected in your arm and as it flows into the blood vessels of the eye, photos are taken. This test tells us whether there is a specific blood vessel that is leaking and causing the problem, and whether it is safe to laser the leaks

Laser

Both ‘photodynamic therapy (PDT)’ and ‘focal laser’ have been used for treatment of CSR, with good success rates. PDT laser requires a special medication to be injected first, which unfortunately is not cover by the Australian government.

Oral Medications

Recent research has found that small groups of people with CSR respond to certain oral medications. This may not be suitable for everyone because it depends on the health of your kidneys and liver.

Intravitreal Injections

The damage to the retina caused by the leak can occasionally result in development of abnormal new blood vessels that leak blood, not just fluid. And this would require injections into the eye.

An example is Anti-VEGF (vascular endothelial growth factor) treatment, which is a group of medicine that reduce new blood vessel growth or oedema (swelling). They are given by an injection into the eye to reduce the risk of scarring and damage to the retina caused by these new vessels.