What Is Central Serous Chorioretinopathy and how to diagnose it?

CSCR or central serous chorioretinopathy is the name given to the disease whereby fluid builds up in the layers beneath the retina. While most patients coming to Best Eye Specialist in Karachi complain of visual loss in one eye, there can be bilateral involvement as well. Read on to know more about central serous chorioretinopathy:

What is central serous chorioretinopathy?

Central serous chorioretinopathy is the fluid buildup beneath the retina, which can impact vision. This fluid can accumulate to the extent that it can partially detach the retina. The greater the detachment of retina, the greater the impact on visual loss. If only a small amount of fluid accumulates beneath the retina, the condition can correct itself without intervention.

What are the symptoms of central serous chorioretinopathy?

As mentioned before, it is more common for one of the eyes to be impacted by central serous chorioretinopathy. However, CSCR in one eye can predispose the other eye to the same condition. The first symptom noticed by the patient is a change in vision. Additional symptoms include:

  • Dimming and distortion of the central vision
  • Darkness in the central vision
  • Grayish tinge to objects, especially white-colored objects giving them a dull appearance
  • Crookedness, bending, and irregularity of straight lines
  • Objects can look farther or smaller than they actually are  

Who is at risk of central serous chorioretinopathy?

The risks of central serous chorioretinopathy include:

  • Men in the age group of 30 to 50 years are more likely to get central serous chorioretinopathy, in comparison to women.
  • Men exposed to chronic stress have more chances of CSCR.
  • People taking systemic or inhaled steroids are more at risk of disease.
  • Type A personalities showing more competitive and aggressive behavior are likely to have central serous chorioretinopathy.
  • Individuals with sleep disturbances or those diagnosed with insomnia tend to have this disease more often.
  • People with sleep apnea, i.e. the condition whereby breathing is interrupted during deep sleep have a higher risk of CSCR.
  • Hypertensive individuals are at higher risk of central serous chorioretinopathy.
  • Another cause of central serous chorioretinopathy is a concurrent autoimmune disorder in which the defense system of the body attacks its own tissues. Examples of autoimmune disorders include rheumatoid arthritis (RA), inflammatory bowel disease (IBD), and systemic lupus erythematosus (SLE).
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How is central serous chorioretinopathy diagnosed?

The diagnosis of central serous chorioretinopathy is based on complete history and examination of the patient. The healthcare provider will dilate the pupil of the eye with topical medication to look at the retina in detail with a handheld lens and biomicroscopy.

Additional investigations can include looking at the retinal blood vessels through fluorescein angiography. In this investigation, a dye is injected into the vein which travels to the blood vessels in the eyes; thereafter, photographs of the retina are taken to look at these blood vessels in detail. Abnormal blood vessels show up the orange on this exam.

Another important investigation is optical coherence tomography (OCT), in which a three-dimensional picture of the retina is obtained, with details of all layers of the retina. The measure of the thickness of the retinal layers and the amount of swelling can also be assessed through OCT.

How is central serous chorioretinopathy treated?

The treatment of central serous chorioretinopathy is mostly observation. It is a self-limiting disease that gets better on its own. During this time, the patient is monitored by the healthcare provider with serial OCTs to check the amount of fluid resorbed in the retina.

In case of further deterioration of vision or nonresolution of symptoms, oral medication, photodynamic therapy, and laser therapy can be used to seal the leak.

Most people have a resolution of symptoms but the vision restored may not be as good as before.

What is the outlook of disease?

If a patient has had CSCR once, there is a risk of subsequent attacks. This is why regular follow-up with an Eye Specialist in Rawalpindi is recommended. In addition, the patient should consult their healthcare provider about the continuous use of steroids for concurrent illnesses that can further increase the risk of central serous chorioretinopathy. In case steroids have to be used, the patient should be on the lookout for similar symptoms.    

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