Central Serous Retinopathy

Question 1

Who does Central Serous Retinopathy (CSR) typically affect?

Answer 1

Young males
Type A personality (“stressed, achievement oriented, competitive, fast-paced, impatient”)

Question 2

Central Serous Retinopathy Risk Factors?

Answer 2

• Steroid use – oral, topical (drops or creams), ask about homeopathic remedies (“like cures like” – drug selected that if given to a healthy individual would cause the presenting symptoms of the patient) as many contain steroid
• Pregnancy
• Stress
• Cushing’s disease – where body produces too much steroid
• Sleep apnoea

Rarely can be associated with optic disc pit – if have px with CSR, always look at optic disc to exclude this

Question 3

Central Serous Retinpathy Symptoms?

Answer 3

• Central blurring of vision
• Distortion
• Scotoma – dark patch in centre of vision
• Hyperopic shift – retina in area of serous detachment is lifted a little and so hyperopic shift

Question 4

Central Serous Retinopathy Signs?

Answer 4

• Pale orange raised area
• May have pigment changes – usually indicates chronicity
• Sub-Retinal Fluid on OCT

Question 5

Treatment & Prognosis of Central Serous Retinopathy?

Answer 5

• Observation
• Usually resolve spontaneously withing 3-6 months
• May have relapsing remitting course (appears, disappears, reappears, disappears) – chronic CSR –> RPE can become affected and there can be a breakdown in the blood-retinal barrier
• Can develop secondary CNV – choroidal neovascularisation
• Treatment:
  o Stop steroids – depends what px is on steroids for – if on oral steroids for systemic condition this isn’t always practical
  o Eplenarone – diuretic, helps to reduce fluid within body
  o Laser (PDT) – for chronic CSR – if can identify point where fluid is leaking from can do laser treatment and seal off the area of leakage and stop the recurrent episodes
   Px selection is v important