Central serous retinopathy (CSR)

CSR typically affects people aged between 20 and 50 and is more common in men than in women. However, it can occur in older people too. In most people, CSR gets better on its own and doesn’t cause long-term changes to vision. In some people it may re-occur. Episodes of CSR that last for a long time or keep coming back are more likely to cause permanent changes in your vision.

This page contains a summary of our information on CSR. To read our full information, download our factsheet:

Macular swelling due to CSR can cause changes to your central vision such as:

• blurring that is painless
• distortion
• blind spots
• dulled colour vision
• seeing objects that appear to be smaller than they actually are
• increased sensitivity to light
• problems seeing an object against a background of a similar colour
• fluctuating vision from one day to another.

In most cases, no cause can be found to explain why CSR is present. This is known as idiopathic CSR. However, several possible risk factors have been identified that could trigger CSR in some people. The condition seems to occur more frequently in people:

• with a Type A personality (people who are more highly competitive, are continually stressed and find it hard to relax)
• who use steroid medication
• during pregnancy
• with Cushing syndrome
• with H.pylori bacterial infection
• sleep apnoea syndrome.

When you’re under stress, your body releases a natural steroid called cortisol into your bloodstream which helps your body to cope.

Although cortisol itself is essential for your health, continuously raised levels of cortisol can sometimes cause problems for your body. This can include immune suppression (reducing the body’s ability to fight infection) and increased fragility and permeability (leakiness) of the blood vessels.

Although cortisol is currently thought to be linked to CSR, it is not thought to be solely responsible for the condition and cannot explain all cases of CSR.

In most cases of CSR, the cause is unknown.

The way CSR may progress can be grouped into three categories.

• Most people will recover within four to six months without any need for treatment.
• CSR which lasts up to 12 months may require treatment
• CSR which lasts over 12 months. This is very rare but can lead to further changes such as RPE detachment or bullous retinal detachment.

Treatment isn’t usually needed for CSR. Most people will find that their vision will improve within three to six months without the need for treatment.

In a small number of people, CSR can be chronic, lasting longer than 12 months. In these cases, sight is more at risk because the retinal layers at the back of your eye can become damaged from prolonged swelling. Therefore, treatment may be recommended for CSR lasting longer than six months.

Most people with CSR don’t require treatment. There are various treatment options available, but they are not licensed or NICE approved for treating the condition. (NICE stands for National Institute for Health and Care Excellence). This means that not every hospital has funding for treatment for CSR. If your CSR doesn’t improve, and you are offered treatment, your ophthalmologist (hospital eye doctor) might suggest thermal laser or photodynamic therapy (PDT).

When deciding on treatment, the ophthalmologist would consider:

• How long you have had CSR, as treatment would only be considered after four to six months of the initial diagnosis.
• If you experience a recurrence of CSR, treatment may be considered sooner.
• Thermal laser treatment isn’t given if the fluid is leaking too close to the centre of the macula because it could cause more harm than good.

Most people with CSR find that their vision gets better on its own and they aren’t left with long term changes to their sight. However, having chronic CSR can cause changes to your vision in the long term, but there are lots of things you can do which will help you adapt to make the most of the vision you still have.

If the eye with CSR was your good eye and you have a sight problem in your other eye, then you may need to make some changes or use low vision aids to make the most of your remaining sight. This may mean making things bigger, using brighter lighting, or using colour to make things easier to see.

You may benefit from having a low vision assessment and you can ask your ophthalmologist, optometrist (optician) or GP about how to access this service in your area. During this assessment, a low vision specialist can discuss with you whether using magnifiers and other aids will help you to see things more clearly.

You can also find out tips for making the most of your sight by downloading our booklet: