What is Central Serous Chorioretinopathy? What Are Its Symptoms? How Is It Diagnosed and Treated?

Central serous chorioretinopathy is an eye condition that occurs more frequently in men, especially between the ages of 35 and 55. Usually affecting one eye, this condition causes fluid to accumulate under your retina. Closely related to stress, the disease may reappear in about half of patients after treatment. In this article, we will discuss in detail what central serous chorioretinopathy is, the symptoms of central serous chorioretinopathy, diagnostic methods, and treatment options for central serous chorioretinopathy.

What is Central Serous Chorioretinopathy?

The accumulation of fluid beneath the retinal layer forms the basis of central serous chorioretinopathy. Fluid leaking from a vascular layer called the choroid, 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 vascular permeability in the choroid layer increases, fluid leakage begins. Deterioration occurring in the retinal pigment epithelium leads to the accumulation of this fluid under the retina. The word "serous" in the name of the disease refers to the type of accumulated fluid.

This condition changes your visual experience quite markedly. You see the image as wavy and blurred, as if you were watching it through a thin layer of water. Some patients report that objects appear smaller than they are or are perceived as if they are standing far away. From the moment fluid collects under the retina, a loss in visual cells begins.

The Role of the Macula Region

Your macula is the region located at the center of your retina and is responsible for your sharp vision ability. Also known as the yellow spot, this area is of vital importance for your daily activities such as reading, face recognition, and distinguishing fine details.

Fluid accumulation usually takes place in this macular region. Therefore, the name of the disease begins with the word "central." Fluid accumulation affecting your central vision point consequently impairs your vision functions that you need the most. However, if the fluid accumulates in an area outside the macula, you may not exhibit any symptoms.

Frequency of the Disease

Central serous chorioretinopathy primarily affects young and middle-aged men. The incidence rate in men ranges from 3 to 10 times higher than in women. While the annual incidence is 9.9 per 100,000 men, this rate has been determined as 1.7 in women.

The disease most frequently appears in individuals between the ages of 25 and 55. It is more common in individuals during their active working period. It usually affects one eye, but both eyes can be involved in 40% of patients.

Acute central serous chorioretinopathy mostly resolves spontaneously within 2-3 months. However, the disease may recur in 30% to 50% of patients. Although it is thought that there may be a genetic predisposition in individuals with a family history of this disease, a specific inheritance pattern has not been identified.

Symptoms of Central Serous Chorioretinopathy

Central serous chorioretinopathy symptoms usually start suddenly and lead to noticeable changes in your visual quality. The most prominent feature of the disease is that it mostly affects one eye. However, when a careful examination is performed, some changes can also be detected in your other eye.

Decrease in Vision in One Eye

Patients most frequently apply with the complaint of a decrease in vision in one eye. This condition directly affects your daily activities. You experience difficulty while reading or doing jobs requiring fine details such as face recognition.

Patients do not have complaints such as pain, redness, or photophobia. This feature is an important point distinguishing central serous chorioretinopathy from other eye diseases. Your eye looks normal from the outside, but your visual quality drops significantly.

Symptoms are usually painless and are seen in one eye in most patients. You may also experience a sudden change in eyeglass prescription.

Distortions and Blurring in Vision

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

Seeing straight lines as crooked, broken, or wavy

Blurring in the center and formation of a blind spot

Seeing objects smaller and farther away than they are

Decrease in visual acuity and difficulty focusing

The phenomenon where straight lines appear curved in particular is called metamorphopsia. While reading a book, lines appear wavy, and window frames are perceived as if they are bent. This condition makes your daily life quite difficult.

A shadow or dark spot may form in the center of your visual field. You see a certain area as dark. Seeing objects smaller than they are is defined as micropsy, and seeing them larger is defined as macropsy.

Changes in Color Perception

Seeing colors as paler is a frequently encountered symptom of the disease. Vibrant colors appear dull and pale to you. Perceiving colors in different tones creates a striking change in your daily life.

This color perception disorder becomes more prominent when you compare your affected eye with your other eye. You notice the color difference when you look at the same object separately with each of your eyes.

Other Symptoms

Symptoms can usually resolve spontaneously within a few weeks to a few months. The fluid at the vision point generally disappears spontaneously within 3 months. In acute central serous chorioretinopathy cases, symptoms may be mild and may resolve spontaneously.

However, in some cases, symptoms may recur or become chronic. It progresses with attacks in 1/3 of the disease. Each new attack lowers your visual acuity a bit more. Therefore, early diagnosis and an appropriate treatment approach are important.

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

Causes of Central Serous Chorioretinopathy

Although the causes of central serous chorioretinopathy are not fully understood, certain disorders in eye structure trigger the disease. A definitive cause has not been determined. However, many factors play a role in the emergence of the disease.

Dysfunction in the Choroid Layer

The disease occurs due to deterioration in the retinal pigment epithelium secondary to increased pressure in the choroid layer, which contains the vessels feeding the outer part of your retina. Choroid tissue is one of the most densely vascularized tissues of your body. The leakage originating from the vessels in this layer is the starting point of the disease.

The leakage leads to deterioration in the retinal pigment epithelium. From the damaged areas in the retinal pigment epithelium, the leakage in the choroid tissue begins to pass under the retina. The disease is more common in individuals whose choroid tissue is thick and more vascular. This condition is an important finding supporting the mechanism of the disease.

Relationship Between Stress and Disease

Psychological stress is the most important risk factor for the development of central serous chorioretinopathy. It is known by most patients as fluid accumulation at the vision point due to stress. High stress levels cause the cortisol hormone to rise.

The body's cortisone level is one of the factors triggering the disease. The cortisol level increases, affecting vascular permeability. It can trigger fluid accumulation under the retina. Therefore, stress management holds critical importance in protection from the disease.

Type A Personality Traits

The disease appears more frequently in individuals carrying Type A personality traits. Cortisone levels increase due to high stress levels in perfectionist individuals. They want to be in control of all events.

They strive to achieve every task they take on. They try to do multiple jobs at the same time. They do not like waiting, and impatience is among their most fundamental traits. They interrupt people who speak slowly. They possess an intense work tempo.

The struggle against time, being impatient, and finishing the job at hand quickly is the sole thought. They want to squeeze multiple tasks into a limited time. They do not even like being inactive on vacation. They work intensely and expect the same from their colleagues.

Risk Factors

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

Use of cortisone-containing medications

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, through the nose, or via the skin can increase the risk. Genetic predisposition is also a condition that needs to be considered. Individuals with a family history of central serous chorioretinopathy have a higher probability of contracting the disease.

Diagnostic Methods and Tests

To make an accurate diagnosis, your ophthalmologist uses 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 first evaluates your eye in general. Then, they use drops to dilate your pupil.

After the drops show their effect, your fundus examination is performed. The physician examines the image of your retina with the help of a special lens. Fluid accumulation under the macula can be observed in this examination. Elevation in the retinal layer can be detected.

Retinal photographs can 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 the diagnosis of central serous chorioretinopathy. Also known as eye tomography, this method allows your retina to be imaged using light waves.

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

Subretinal fluid and retinal pigment epithelium changes are clearly monitored. It can show even early pathological changes that cannot be detected clinically. It makes it possible to detect very small degrees of fluid or the mark remaining after the fluid is withdrawn.

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

Fundus Fluorescein Angiography (FFA)

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

A picture of each eye is taken to detect dye leakage under the patient's retina. Leakage points are detected with the dyed substance given from the vessel. The location and type of fluid leakage are determined.

Along with OCT, this test allows your doctor to make the diagnosis of central serous chorioretinopathy. It makes it possible to distinguish it from other retinal diseases causing fluid inside the macula.

Indocyanine Green Angiography (ICGA)

Indocyanine green angiography examines choroid vessels in detail. Choroidal vascular structure and perfusion disorders are evaluated.

This test may need to be performed on patients who need to undergo central serous chorioretinopathy treatment. It is useful to find the leakage source of the fluid accumulating under the retina and to confirm the diagnosis.

This method is utilized to be able to demonstrate mid-phase hyperfluorescence in situations where a definitive diagnosis cannot be made. It assists in differential diagnosis in chronic and atypical situations.

Central Serous Chorioretinopathy Treatment

Central serous chorioretinopathy treatment is not required in the majority of patients. In approximately 85%, the disease heals spontaneously within 3 months. During this process, your doctor recommends follow-up instead of active intervention.

Follow-up and Waiting Period

Observation is preferred instead of treatment in the first 3 months. 80-90% of acute cases resolve spontaneously within 3 to 6 months. Your visual acuity rises to normal levels. During this waiting period, you need to stay away from stress.

If you are using cortisone-containing medications, it is recommended to stop them under doctor supervision. It should not be forgotten that suddenly quitting high-dose steroid medications can cause medical problems. Therefore, coordination with your relevant doctor is important.

Whether the fluid under the retina has disappeared or not should be monitored with OCT at regular intervals. If the fluid does not disappear in 3-4 months and vision loss continues, treatment is required.

Medical Treatment Options

Lifestyle changes are the first step of treatment. Reducing stress, quitting smoking, keeping blood pressure under control, and exercising regularly are recommended. Healthy nutrition also plays a supporting role.

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

Laser Treatment

Focal laser photocoagulation is applied by determining the leakage area and closing it with low-dose laser. It can be applied in selected cases. It is preferred if the leakage point is far from the vision center.

Micropulse laser stabilizes the regions causing leakage. It is different from classical laser and leaves no scar. The procedure is painless, 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 given intravenously, and infrared laser is applied. It is the most effective treatment option in chronic cases.

The success rate has been reported in the range of 80% to 97%. Recurrence rates are also less compared to those healing spontaneously. You are asked not to go out into sunlight in the first days after treatment. The net effect appears one month later.

Psychological Support and Stress Management

Patients with Type A personality may need to receive psychological counseling. These individuals are perfectionist, competitive, and overexert themselves. Individuals experiencing sleep problems are frequently encountered.

Depression and anxiety scores are higher in chronic patients. Healthcare professionals need to direct 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 frequently recurs, treatment is delayed, or it becomes chronic, permanent damage can form in the macula. It progresses with relapses in 50% of patients. Regular follow-up is therefore important.

Frequently Asked Questions

We have compiled the topics most wondered about by patients regarding the disease. The following questions and answers will clarify the situations you may encounter during your treatment process.

Why does central serous chorioretinopathy usually occur in men?

The disease appears more frequently in men especially between the ages of 25-50. Although the exact reason for this is not known, it is thought that hormonal and vascular sensitivity in men triggers this picture. Furthermore, differences in stress and cortisol levels can also play a role.

Is treatment necessary if it heals spontaneously?

In most cases, central serous chorioretinopathy regresses spontaneously within a few months. However, close follow-up is important during this period. Your doctor determines the intervention time by monitoring the course of fluid accumulation. Regular checks are required against the risk of permanent damage in the vision center.

Does this disease recur?

Yes, it can recur. In some of the people who have experienced the disease, fluid accumulation can form again in the same eye or the other eye over the years. The risk of recurrence increases especially in individuals under chronic stress. The recurrence rate is around 40%.

Does central serous chorioretinopathy cause vision loss?

It generally progresses with temporary visual impairment. However, if fluid stays under the retina for a long time or the disease frequently recurs, permanent impairment can occur in the vision center. Unfollowed and chronic situations lead to permanent vision decrease.

Can I continue working with this disease?

Generally yes. However, blurred vision and image distortion can lead to temporary performance problems especially in those working in front of screens. Taking measures to reduce eye fatigue and giving rest breaks will be useful.

Is central serous chorioretinopathy only related to stress?

Stress is one of the biggest triggers. High stress can affect vascular permeability by increasing the cortisol level. However, cortisone medications, genetic factors, and sleep disorders can also affect the disease. In other words, not stress alone, but multiple factors play a role together.

I am using cortisone, will central serous chorioretinopathy develop?

Yes, cortisone-containing medications can increase the risk of the disease. All corticosteroid forms including pills, creams, and nasal sprays can be effective. Therefore, it is recommended that patients using chronic cortisone take eye complaints seriously and have a retinal examination.

Will I recover completely after central serous chorioretinopathy treatment?

Most patients regain normal vision after central serous chorioretinopathy treatment. However, permanent marks such as slight fluctuations in visual quality or a decrease in color sensitivity can remain in some people. This condition is usually seen in late-diagnosed or chronicized cases.

Is the treatment painful?

Micropulse laser applications are painless, and drop anesthesia is sufficient. Modern treatment methods have been developed focusing on comfort.

In Summary, Central Serous Chorioretinopathy

Central serous chorioretinopathy is a condition that mostly resolves spontaneously. When the fluid disappears within a few months, your vision returns to normal. Nevertheless, keeping stress under control holds critical importance 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 a sudden change in your vision, apply to your ophthalmologist immediately. Early diagnosis prevents permanent damage and increases your treatment options. When you comply with the follow-up program recommended by your doctor, you can keep the course of the disease under control and protect your visual quality.

Central serous chorioretinopathy is an eye disease frequently seen in men aged 35-55. In this article, we discuss its symptoms, diagnostic methods, and treatment options.