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 about half of the patients after treatment. In this article, we will discuss what central serous chorioretinopathy is, its symptoms, diagnostic methods, and treatment options in detail.
What is Central Serous Chorioretinopathy?
The accumulation of fluid beneath the retinal layer forms the basis of central serous chorioretinopathy. Fluid leaking from the choroidal 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 choroidal 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 looking through a thin layer of water, making them appear wavy and blurry. Some patients report that objects appear smaller than they are or seem to be at a distance. Loss of visual cells begins as soon as fluid accumulates beneath the retina.
The Role of the Macula Region
Your macula is the area located at the center of your retina and is responsible for your sharp vision. Known as the yellow spot, 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 begins with the word “central.” Fluid accumulation affecting your central vision point disrupts the visual functions you need the most. However, if the fluid accumulates 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 in men is 3 to 10 times higher than in women. The annual incidence rate is 9.9 per 100,000 men, while this rate is 1.7 in women.
The disease most commonly appears in individuals aged between 25 and 55. It is more prevalent among those in their active working years. 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
Symptoms of central serous chorioretinopathy typically begin suddenly and lead to noticeable changes in your visual quality. The most distinctive feature of the disease is that it usually affects one eye. However, upon careful examination, some changes may be detected in the other eye as well.
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 a significant 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 sudden changes 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 bent, broken, or wavy
- Blurred vision and the formation of blind spots in the center
- Seeing objects as smaller and farther away than they are
- Decreased visual acuity and difficulty focusing
Especially, the appearance of straight lines as curved is referred to as metamorphopsia. While reading a book, lines may appear wavy, and window frames may be perceived as distorted. 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 as smaller is called micropsia, while seeing them as larger is termed macropsia.
Changes in Color Perception
Seeing colors as more muted is one of the common symptoms of the disease. Bright colors appear dull and faded 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 your affected eye with your other eye. You notice the color difference when looking at the same object with both eyes separately.
Other Symptoms
Symptoms typically resolve on their own within a few weeks to a few months. The fluid in the visual center usually disappears within 3 months. In cases of acute central serous chorioretinopathy, symptoms may be mild and can resolve spontaneously.
However, in some cases, symptoms may recur or become chronic. The disease progresses with attacks in one-third of cases. Each new attack may further decrease 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. A definitive cause has not been identified. However, many factors play a role in the onset of the disease.
Functional Disorders in the Choroidal Layer
The disease occurs secondary to increased pressure in the choroidal layer, which contains the vessels that nourish the outer part of your retina, leading to disruption in the retinal pigment epithelium. The choroidal 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. Leakage from damaged areas in the retinal pigment epithelium begins to pass beneath the retina from the choroidal tissue. The disease is more common in individuals with thicker and more vascular choroidal tissue. This 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 stress levels lead to an increase in cortisol hormone.
The level of cortisol in the body is one of the factors triggering the disease. An increase in cortisol levels affects 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, high stress levels lead to increased cortisol levels. They want to have control over all events.
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.
Struggling against time, they impatiently focus on quickly finishing the task at hand. They want to fit multiple tasks into a limited time. Even on vacation, they do not like inactivity. They work intensely 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. Cortisone-containing medications taken orally, nasally, or through the skin can increase the risk. Genetic predisposition is also a factor to consider. Individuals with a family history of central serous chorioretinopathy are more likely to develop the disease.
Diagnostic Methods and Tests
To make an accurate diagnosis, your eye doctor uses several different examination methods. Each test reveals different aspects of the disease and provides necessary information for treatment planning.
Fundus Examination
Your eye examination begins with a routine check. Your doctor first evaluates your eye generally. Then, they use drops to dilate your pupil.
After the drops take effect, your fundus examination is performed. The doctor examines the image of your retina using a special lens. Fluid accumulation beneath the macula can be observed during this examination. Elevation in the retinal layer can 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 the fluid has been removed.
OCT imaging is repeated during 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. This substance, given through the venous route, provides a black-and-white image of the vascular structures of the fundus.
To detect dye leakage beneath the retina, images of each eye are taken. The leakage points are identified using the dye injected into the vein. The location and type of fluid leakage are determined.
Together with OCT, this test allows your doctor to diagnose central serous chorioretinopathy. It helps distinguish 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 required for patients who need treatment for central serous chorioretinopathy. It is useful for finding the source of leakage of fluid accumulating beneath the retina and confirming 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 cases resolve spontaneously within 3 months. During this process, your doctor may 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 need to stay away from 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 necessary.
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 may be used.
Laser Treatment
Focal laser photocoagulation is performed 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 medication is administered intravenously, followed by infrared laser application. It is the most effective treatment option for chronic cases.
The success rate is reported to be between 80% and 97%. Recurrence rates are also lower compared to those who resolve spontaneously. After treatment, patients are advised to avoid sunlight for the first few days. 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 overexert 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 resolve 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.
Why is central serous chorioretinopathy more commonly seen in men?
The disease occurs more frequently in men aged 25-50. Although the exact reason is not known, it is thought that hormonal and vascular sensitivities in men trigger this condition. Additionally, differences in stress and cortisol levels may also play a role.
If it resolves on its own, is treatment necessary?
In most cases, central serous chorioretinopathy resolves on its own within a few months. However, close monitoring during this period is important. Your doctor will determine the timing of intervention by monitoring the course of fluid accumulation. Regular check-ups are necessary to prevent the risk of permanent damage to the visual center.
Does this disease recur?
Yes, it can recur. Some individuals who have had the disease may experience fluid accumulation in the same or the other eye over the years. The risk of recurrence is higher in individuals under chronic stress. The recurrence rate is around 40%.
Does central serous chorioretinopathy cause vision loss?
It generally presents with temporary visual disturbances. However, if fluid remains beneath the retina for a long time or if the disease recurs frequently, permanent damage may occur in the visual center. Unmonitored and chronic conditions can lead to permanent vision loss.
Can I continue to work with this disease?
Generally, yes. However, visual blurriness and image distortion may lead to temporary performance issues, especially for those working in front of screens. Taking measures to reduce eye strain and taking breaks can be beneficial.
Is central serous chorioretinopathy only related to stress?
Stress is one of the biggest triggers. High stress can increase cortisol levels, affecting vascular permeability. However, cortisone medications, genetic factors, and sleep disorders can also influence the disease. Therefore, it is not solely stress, but multiple factors play a role together.
Does using cortisone increase the risk of developing central serous chorioretinopathy?
Yes, medications containing cortisone can increase the risk of the disease. All forms of corticosteroids, including pills, creams, and nasal sprays, can be effective. Therefore, patients using chronic cortisone should take their eye complaints seriously and undergo retinal examinations.
Will I fully recover after treatment for central serous chorioretinopathy?
Most patients regain normal vision after treatment for central serous chorioretinopathy. However, some individuals may have slight fluctuations in visual quality or a decrease in color sensitivity as lasting effects. This situation is usually seen in cases of late diagnosis or chronic cases.
Is the treatment painful?
Micro pulse laser applications are painless, and drop anesthesia is sufficient. Modern treatment methods are developed with a focus on comfort.
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 the follow-up program recommended by your doctor, you can keep the course of the disease under control and preserve your visual quality.
Central serous chorioretinopathy is a common eye disease seen in men aged 35-55. In this article, we discuss its symptoms, diagnostic methods, and treatment options.
