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Central Serous Retinopathy

Central serous retinopathy (CSR) is a blister on the retina cause by a fluid leak under the macula. The macula is the center of the retina. It is responsible for center vision, for the image of what you look directly at, so it provides the image you see when trying to read or do fine work. When the macula becomes distorted it disrupts your center vision.

CSR usually appears in one eye at a time, but can affect both eyes at the same time. Symptoms can include:

  • A disk or oval shape shadow or discolored area in or near the center of vision that may appear grey, brown, or different colors depending on the color of what you are looking at much like an afterimage from looking at a bright light
  • A blind spot in the center or your vision
  • Letters look smaller and/or wavy within the affected area of vision
  • Difficulty focusing, especially in dim or very bright light
  • Difficulty seeing fine detail
  • Color distortion

In some cases, the blister is small and not "dead center" so there are no noticeable symptoms and the condition only shows up during an eye exam.

How it works
CSR occurs when fluid accumulates under the retina. A layer of cells called the retinal pigment epithelium (RPE) normally acts as a barrier, preventing fluid from flowing freely. When the RPE develops small leaks the fluid is allowed to flow under the retina forming a small bubble in the macula.

When you see, light is focused on your retina. The macula is in the center of your retina and allows you to see fine detail. When the macula is distorted the light is not focused properly and your vision is distorted as well.

In most cases the leak stops on its own within a month or two. After the leak stops it can take several months for the blister to heal and vision to go back to normal.

Vision loss
One, brief episode of CSR does not usually cause any permanent vision loss. However it is common for it to come back or appear in the other eye. A long episode or multiple episodes can cause scarring and permanent vision loss.

Some people will develop abnormal blood vessel growth, called choroidal neovascularization, which also causes vision loss.

Laser surgery can be used to stop the leak or leaks, but is reserved for severe cases. The surgery will create a small scar causing a small area of permanent vision loss.

The cause is not truly known, but there are some factors typically associated with CSR. Stress and steroid use seem to be the primary causes.

CSR is most common in young, healthy, Type A males, but can occur in females. It is believed that catecholomines, which are released into the bloodstream when we experience stress, break down the RPE. It is common for CSR and recurrences to appear during or immediately after times of extreme stress.

Steroid use has also been associated with CSR and will worsen the condition. This includes cortisone creams and some asthma inhalers as well as other medications that people often do not realize contain steroids.

When to see your eye doctor
Although CSR normally goes away on its own, you should see your ophthalmologist right away for diagnosis and to rule out more serious conditions that need immediate treatment to preserve your vision. The symptoms of CSR can be very similar to the symptoms of wet macular degeneration which can progress quickly and can cause severe and permanent vision loss.

If it is, in fact, CSR you will probably not need treatment, but you will need to immediately cease any steroid use, and avoid steroids for the rest of your life to prevent recurrence. You will also need to make lifestyle changes, reducing stress or improving stress management, and incorporating eye-healthy foods into your diet.

If you are experiencing any of the symptoms of CSR, please contact your ophthalmologist and schedule an eye exam today.

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