Central Serous Chorioretinopathy - Northern Eye Centre

What is the retina?

The retina is the inside lining of the back of the eye. It is composed of many layers of light sensitive nerve cells. Light entering the eye is focused on the retina and is converted to electrical impulses which are carried to the brain by the optic nerve. The centre of the retina is called the macula. It is the most sensitive part of the retina and is used for day light and colour vision. This is in contrast to the rest of the retina which is more sensitive in the dark and is mainly used for navigational black and white vision at night.

The retina is supplied by one main artery and one main vein which enter through the optic nerve and branch all over the retina to smaller arteries and veins that cross each other’s like railway tracks.

source – American Academy Ophthalmology

How does the eye work?

What is Central Serous Chorioretinopathy (CSC)?

The retina needs to be dry to work properly. There is a deep layer under the retina called the retinal pigment epithelium (RPE) which continuously pumps fluid out from the retina. In CSC , there is some disturbance in this action at the choroid (deeper vascular layer) or the RPE layers so fluid starts to accumulate like a blister under the retina usually at the macula. As a result, a small detachment of the macula occurs.

What are the symptoms of Central Serous Chorioretinopathy (CSC)?

Blurred vision: patient will describe a circle like central blurred spot in the vision of one eye.
Central distortion: described as bending of lines in the central vision
Dim vision
Colour vision change

Who is at risk of getting Central Serous Chorioretinopathy (CSC)?

The cause of CSC is still not fully know but it is thought to be related to increase of systemic steroids (corticosteroids).

Young males in their 30s to 50s age are at higher risk than females
Type A personality and increased emotional stress
Steroid medications: such as prednisone tablets, asthma steroid puffers and steroid skin cream usage
Caffeine and energy drink intake
Genetic tendency
High blood pressure and heart disease
Pregnancy
Other drugs such as stimulants, decongestants, erectile dysfunction medications and some anti-cancer agents

How to diagnose Central Serous Chorioretinopathy (CSC)?

Symptoms and age of patient are highly suggestive of the condition.
Dilated retina examination: This is the standard test to check the back of your eye (retina). You will have your pupil dilated with drops so your vision will be blurry for an hour or two after the examination. Our specialist will check your eyes on the microscope (slit lamp) and uses a special lens to see the details of the retina. Peripheral retina will be checked with another instrument called indirect ophthalmoscope. You will also receive full examination of both eyes including the front of the eye (anterior segment).

OCT (optical coherence tomography); this is a fast scan of retina centre (macula) which shows cross section details of its layers.

OCT of central serous chorioretinopathy

Fundus Fluorescein Angiography (FFA) A fluorescent dye is injected into a vein in the arm or hand. The dye circulates rapidly in the body reaching the retina in a few seconds. A special camera will then take multiple quick pictures which show the dye in the retinal circulation clearly. In new cases, FFA will show the site of leakage at the retinal pigment epithelium (RPE)-choroid. In chronic CSC, a specific pattern of RPE damage will be shown.

Central serous chorioretinopathy
source: American Society of Retina Specialists

Chronic central serous chorioretinopathy
source – American Society of Retina Specialists

What is the treatment of Central Serous Chorioretinopathy (CSC)?

In many cases, CSC will spontaneously improve over a few weeks. The blister of fluid under the retina will resolve and vision improves without any intervention.
If you are on any of the medications known to be associated with CSC, you need to seek your family doctor’s advice about stopping them as in many cases it will help to resolve the condition.
Laser: if the condition persists for more than 12 weeks and a specific site of leakage is identified, then thermal laser will be applied. Laser has a high success rate.
In chronic cases of CSC other treatment modalities are available such as :
- Systemic medications
  Various drugs are currently used for the treatment of chronic CSC such as mineralocorticoid receptor antagonist Eplerenone and Spironolactone, glucocorticoid receptor antagonist Miepristone and antibacterial drug Rifampin.
- Photodynamic Laser therapy (PDT)
  This treatment involves the combination of cold low- power laser and a light activated drug called photosensitiser. The aim of the laser is to destroy abnormal ‘leaky’ blood vessels.The procedure is performed at the Northern Eye Centre. It involves injecting the photosensitiser drug slowly into a vein in your arm. The drug will circulate in your body and reaches your retina. The low powered laser beam will then be applied to the location of the abnormal blood vessels under the macula through a special lens. The procedure is completely painless but takes some time to perform.You will be advised to avoid strong sunlight over the following 3 days. The procedure can be repeated after a few months. PDT is currently only used in a few selected cases and can be combined with anti-VEGF injections.

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