What is Central Serous Chorioretinopathy? What are its Symptoms? How is Diagnosis and Treatment Done?

Central serous chorioretinopathy is an eye disorder that is more commonly seen in men aged between 35 and 55. This condition, which usually affects one eye, causes fluid accumulation beneath your retina. Closely related to stress, the disease can recur in approximately half of the patients after treatment. In this article, we will discuss what central serous chorioretinopathy is, what its symptoms are, the diagnostic methods, and the treatment options in detail.

What is Central Serous Chorioretinopathy?

The accumulation of fluid beneath the retinal layer forms the basis of central serous chorioretinopathy. The fluid leaking from the choroid, a vascular layer located at the back of your eye, collects under your retina. This fluid accumulation separates your retina from its normal position and directly affects your visual quality.

Fluid Accumulation in the Retina and Its Effects

When the permeability of the vessels in the choroid layer increases, fluid leakage begins. The disruption occurring in the retinal pigment epithelium leads to the accumulation of this fluid beneath the retina. The term “serous” in the disease’s name refers to the type of fluid that accumulates.

This condition significantly alters your visual experience. You see images as if you are viewing them through a thin layer of water, appearing wavy and blurry. Some patients report that objects appear smaller than they are or seem to be at a distance. Loss of vision cells begins as soon as fluid accumulates beneath the retina.

The Role of the Macula Region

Your macula is the area located in the center of your retina and is responsible for your sharp vision. Also known as the fovea, this area is vital for daily activities such as reading, face recognition, and distinguishing fine details.

Fluid accumulation usually occurs in this macula region. Therefore, the disease’s name starts with the term “central.” Fluid accumulation affecting your central vision point disrupts your most needed visual functions. However, if the fluid accumulates outside the macula, you may not exhibit symptoms.

Frequency of the Disease

Central serous chorioretinopathy primarily affects young and middle-aged men. The incidence in men is 3 to 10 times higher than in women. The annual incidence is 9.9 per 100,000 men, while this rate is 1.7 in women.

The disease most commonly occurs in individuals aged 25 to 55. It is more prevalent in those who are actively working. It usually affects one eye, but in 40% of patients, both eyes may be involved.

Acute central serous chorioretinopathy often resolves spontaneously within 2-3 months. However, the disease may recur in 30% to 50% of patients. Although there may be a genetic predisposition in individuals with a family history of this disease, no specific inheritance pattern has been identified.

Symptoms of Central Serous Chorioretinopathy

The symptoms of central serous chorioretinopathy usually begin suddenly and lead to noticeable changes in your visual quality. The most distinctive feature of the disease is that it often affects only one eye. However, upon careful examination, some changes may also be detected in the other eye.

Decreased Vision in One Eye

Patients most commonly present with complaints of decreased vision in one eye. This condition directly affects your daily activities. You may struggle with tasks that require fine detail, such as reading or recognizing faces.

Patients do not experience pain, redness, or inability to look at light. This feature is an important point that distinguishes central serous chorioretinopathy from other eye diseases. Your eye appears normal from the outside, but your visual quality significantly decreases.

Symptoms are generally painless and are usually observed in one eye. You may also experience a sudden change in your glasses prescription.

Distortions and Blurriness in Images

Various distortions in images stand out among the symptoms of central serous chorioretinopathy:

• Seeing straight lines as crooked, broken, or wavy
• Blurriness and the formation of a blind spot in the center
• Seeing objects smaller and at a distance than they are
• Decreased visual acuity and difficulty focusing

Especially, the appearance of straight lines as curved is called metamorphopsia. When reading a book, the lines appear wavy, and window frames are perceived as bent. This condition significantly complicates your daily life.

You may notice a shadow or dark spot forming in the center of your visual field. You see a certain area as dark. Seeing objects smaller than they are is called micropsia, while seeing them larger is termed macropsia.

Changes in Color Perception

Seeing colors as more faded is one of the common symptoms of the disease. Bright colors appear dull and pale to you. The perception of different shades of colors creates a noticeable change in your daily life.

This color perception disorder becomes more pronounced when you compare the affected eye with your other eye. You notice the color difference when looking at the same object with both eyes separately.

Other Symptoms

Symptoms generally resolve spontaneously within a few weeks to a few months. The fluid in the visual center typically disappears within 3 months. In cases of acute central serous chorioretinopathy, symptoms may be mild and resolve on their own.

However, in some cases, symptoms may recur or become chronic. The disease progresses with attacks in one-third of cases. Each new attack slightly decreases your visual acuity. Therefore, early diagnosis and appropriate treatment approach are important.

Depending on the localization and amount of fluid, you may not exhibit symptoms, especially if the affected areas are outside the macula.

Causes of Central Serous Chorioretinopathy

Although the causes of central serous chorioretinopathy are not fully understood, certain abnormalities in the eye structure trigger the disease. No definitive cause has been identified. However, many factors play a role in the emergence of the disease.

Functional Disorder in the Choroid Layer

The disease occurs due to increased pressure in the choroid layer, which contains the vessels that nourish the outer part of your retina, secondary to disruption in the retinal pigment epithelium. The choroid tissue is one of the most vascularized tissues in your body. Leakage from the vessels in this layer is the starting point of the disease.

Leakage leads to disruption in the retinal pigment epithelium. The leakage from damaged areas in the retinal pigment epithelium begins to pass beneath the retina from the choroid tissue. The disease is more frequently seen in individuals with thicker and more vascular choroid tissue. This condition is an important finding supporting the mechanism of the disease.

Relationship Between Stress and the Disease

Psychological stress is the most significant risk factor for the development of central serous chorioretinopathy. It is known as fluid accumulation in the visual center due to stress by most patients. High levels of stress lead to an increase in cortisol hormone.

The body’s cortisol level is one of the factors that trigger the disease. Increased cortisol levels affect vascular permeability. It can trigger fluid accumulation beneath the retina. Therefore, stress management is critically important in preventing the disease.

Type A Personality Traits

Individuals with Type A personality traits are more likely to develop the disease. In perfectionist individuals, the stress level increases due to their desire to control all events, leading to elevated cortisol levels.

They strive to succeed in every task they undertake. They try to do multiple tasks simultaneously. They dislike waiting, and impatience is one of their fundamental characteristics. They interrupt slow speakers. They have an intense work pace.

The struggle against time is characterized by the desire to finish the task at hand quickly. They want to fit multiple tasks into a limited time. They do not like inactivity even on vacation. They work hard and expect the same from their colleagues.

Risk Factors

Men are at least 3 times more at risk than women. Other reported risk factors for central serous chorioretinopathy include:

• Use of medications containing cortisone
• Smoking
• Sleep apnea
• Pregnancy
• Insomnia
• Hypertension
• Excessive caffeine consumption

Long-term use of steroid-containing medications increases the risk of developing the disease. Medications containing cortisone taken orally, nasally, or through the skin can increase the risk. Genetic predisposition is also a consideration. Individuals with a family history of central serous chorioretinopathy have a higher likelihood of developing the disease.

Diagnostic Methods and Tests

To make an accurate diagnosis, your eye doctor will use several different examination methods. Each test reveals different aspects of the disease and provides the necessary information for treatment planning.

Fundus Examination

Your eye examination starts with a routine check. Your doctor will first evaluate your eye in general. Then, they will use drops to dilate your pupil.

After the drops take effect, your fundus examination will be performed. The doctor examines the image of your retina with a special lens. Fluid accumulation beneath the macula can be observed in this examination. Elevation in the retinal layer may be detected.

Retinal photographs may be taken to document the appearance of the disease. These photographs allow you to make comparisons during the treatment process.

OCT (Optical Coherence Tomography) Examination

Optical coherence tomography is the gold standard in diagnosing central serous chorioretinopathy. Also known as eye tomography, this method uses light waves to visualize your retina.

OCT is completely harmless and has no side effects. It allows your doctor to see the retina at a microscopic level. It shows the retinal layers in detail.

Subretinal fluid and changes in the retinal pigment epithelium can be clearly monitored. It can even show early pathological changes that are clinically undetectable. It allows for the detection of very small amounts of fluid or the residue left after fluid withdrawal.

OCT scans are repeated in the follow-up of the disease. This test is necessary to show whether the fluid beneath the retina has decreased or disappeared.

Fundus Fluorescein Angiography (FFA)

Fluorescein angiography is performed by injecting a special dye into your arm. With this substance given via the venous route, a black-and-white image of the vascular structures of the fundus is obtained.

To detect leakage of dye beneath the retina, images of each eye are taken. The location and type of fluid leakage are determined using the dye injected into the vein. This test, along with OCT, allows your doctor to diagnose central serous chorioretinopathy. It distinguishes it from other retinal diseases that cause fluid in the macula.

Indocyanine Green Angiography (ICGA)

Indocyanine green angiography examines the choroidal vessels in detail. It evaluates the choroidal vascular structure and perfusion disorders.

This test may be necessary for patients who require treatment for central serous chorioretinopathy. It is useful to find the source of leakage of fluid accumulating beneath the retina and to confirm the diagnosis.

In cases where a definitive diagnosis cannot be made, this method is used to demonstrate mid-phase hyperfluorescence. It helps in differential diagnosis in chronic and atypical cases.

Treatment of Central Serous Chorioretinopathy

Most patients do not require treatment for central serous chorioretinopathy. Approximately 85% of the cases heal spontaneously within 3 months. During this process, your doctor will recommend monitoring instead of active intervention.

Monitoring and Waiting Process

In the first 3 months, observation is preferred instead of treatment. 80-90% of acute cases resolve spontaneously within 3 to 6 months. Your visual acuity returns to normal levels. During this waiting period, you should avoid stress.

If you are using cortisone-containing medications, it is recommended to discontinue them under doctor supervision. It should be noted that abruptly stopping high-dose steroid medications can cause medical problems. Therefore, coordination with your doctor is important.

The disappearance of fluid beneath the retina should be monitored regularly with OCT. If the fluid does not disappear within 3-4 months and vision loss continues, treatment is required.

Medical Treatment Options

Lifestyle changes are the first step in treatment. It is recommended to reduce stress, quit smoking, control blood pressure, and engage in regular exercise. Healthy eating also plays a supportive role.

Some medications may be prescribed to accelerate fluid absorption. Non-steroidal anti-inflammatory drugs and anti-glaucoma drops can be used.

Laser Treatment

Focal laser photocoagulation is applied by identifying the leakage area and closing it with low-dose laser. It can be applied in selected cases. It is preferred when the leakage point is away from the visual center.

Micro pulse laser stabilizes the leaking areas. It is different from classical laser and leaves no scars. The procedure is painless, and drop anesthesia is sufficient.

Photodynamic Therapy

Today, it is the gold standard in the treatment of central serous chorioretinopathy. The light-sensitive Visudyne drug is administered intravenously, followed by infrared laser application. It is the most effective treatment option in chronic cases.

The success rate is reported to be between 80% and 97%. The recurrence rates are also lower compared to those who heal spontaneously. Patients are advised not to expose themselves to sunlight in the first few days after treatment. The clear effect appears after one month.

Psychological Support and Stress Management

Patients with Type A personality may require psychological counseling. These individuals are perfectionist, competitive, and tend to overwork themselves. Sleep problems are commonly observed.

Chronic patients have higher scores for depression and anxiety. Health professionals should refer patients for psychosocial support.

Treatment Success Rates

In most patients, vision returns to normal over time. Most mild cases heal spontaneously within a few months without treatment. However, if the disease recurs frequently, treatment is delayed, or it becomes chronic, permanent damage may occur in the macula. The disease progresses with recurrences in 50% of patients. Regular follow-up is therefore important.

Frequently Asked Questions

We have compiled the most frequently asked questions by patients about the disease. The questions and answers below will clarify situations you may encounter during your treatment process.

In Summary: Central Serous Chorioretinopathy

Central serous chorioretinopathy is mostly a self-resolving condition. When the fluid disappears within a few months, your vision returns to normal. However, controlling stress is critically important to prevent the recurrence of the disease. Use cortisone-containing medications under doctor supervision and do not neglect your regular eye examinations.

If you notice sudden changes in your vision, consult your eye doctor immediately. Early diagnosis prevents permanent damage and increases your treatment options. By adhering to your doctor’s recommended follow-up program, you can control the course of the disease and preserve your visual quality.