serous chorioretinopathy



• Central serous chorioretinopathy, also called central serous retinopathy or idiopathic central serous retinopathy, is an ocular condition characterized by:

– Serous retinal detachment, typically seen in the macular region

– One or more retinal pigment epithelial detachments, which are generally less than 300 microns across, are responsible for the leakage of plasma into the subretinal space.

– Signs and symptoms are limited to the eye.

– Rarely, bullous central serous chorioretinopathy can be associated with a large serous retinal detachment with shifting subretinal fluid. Retinal pigment epithelial leaks in this variant are typically greater than 500 microns across.



• Men outnumber women by a factor of 6:1.

• The mean annual age-adjusted incidence per 100,000 for men is 9.9 (95% confidence interval [CI], 7.4–12.4).

• The mean annual age-adjusted incidences per 100,000 for women is 1.7 (95% CI, 0.7–2.7).

• Approximately two-third of fellow eyes followed for 10 years demonstrate some evidence, (although often asymptomatic) of central serous chorioretinopathy.

• The entity is most typically encountered in patients aged 25–50 years.

• Recurrence:

– Approximately 30% of cases will experience a recurrence

– The median time of recurrence is 1.3 years

– Recurrences have been seen from 3 months to 18 years


• Use of corticosteroids

• Type “A” personality profile

• Cushing’s disease


No genetic or hereditary association has routinely been described.


• Since central serous chorioretinopathy appears to be associated with the classic type A personality profile, patients should at least be informed of the association.

• Patients should be cautioned about the association of glucocorticosteroid use and central serous chorioretinopathy.


A retinal pigment epithelial detachment, or other leak at the retinal pigment epithelium level, facilitates the leakage of plasma into the subretinal space.


• Plasma from the choroid travels through damaged retinal pigment epithelium and into the subretinal space.

• The cause of the leak is uncertain, although glucocorticosteroids have been implicated in select cases.

• An association with Helicobacter pylori was noted in one paper, but this association needs confirmation.


• Central serous chorioretinopathy is often associated with a “type A” personality profile

• Recent use of glucocorticosteroids


• A serous detachment of the sensory retina is seen in the macular region with ophthalmoscopy.

• Subretinal precipitates can be seen on the underside of the retina in select cases.

• The presence of subretinal and/or intraretinal blood rules out the diagnosis of central serous chorioretinopathy.

• The anterior segment is uninvolved.

• Intravenous fluorescein angiography discloses one or more leaks at the level of the pigment epithelium. The leaks are often difficult to see ophthalmoscopically.

• Leaks can occur superiorly to the posterior pole view. Thus, the fluorescein angiographic photographer should take at least 1 frame in this region.


• Patients most often complain about a gray or black spot centrally

• Micropsia is also often present

• Metamorphopsia is present in two-third of affected eyes

• A history of severe stress (losing a loved one, a house, or a job) may be present

• The use of some form of corticosteroid (oral, injected, or topical) may be present


• Ophthalmoscopic examination demonstrates a serous detachment of the sensory retina, most often involving the central macular retina.

• Subretinal precipitates may be seen on the underside of the detached sensory retina.

• Retinal or subretinal blood is not seen with this entity. If blood is present, consider neovascular macular degeneration.


Diagnostic Procedures/Other

• Intravenous fluorescein angiography typically demonstrates a focal area of hyperfluorescence corresponding to a retinal pigment epithelial detachment leaking plasma into the subretinal space.

– A “smokestack” pattern of leakage can be seen as the fluorescein dye rises within the subretinal space in 20% of cases.

– Fluorescein leakage may be sufficient to produce hyperfluorescence throughout the entire retinal detachment.

– In more chronic cases, one or more linear streaks of “guttering”, characterized by retinal pigment changes can be seen. This occurs secondary to chronic subretinal fluid tracking inferiorly.

• Optical coherence tomography generally reveals a retinal pigment epithelial detachment associated with a larger area of overlying serous retinal detachment.

Pathological Findings

A serous, sensory retinal detachment associated with a smaller retinal pigment epithelial detachment.


• Entities in the differential diagnosis for central serous chorioretinopathy include those which can produce serous detachment of the sensory retina in the posterior pole.

– Neovascular macular degeneration, age-related or from other causes

– Polypoidal choroidal vasculopathy

– Subretinal or intraretinal fluid associated with a congenital pit of the optic nerve head

– Shallow rhegmatogenous retinal detachment

– Severe hypertensive retinopathy with serous retinal detachment due to hypertensive choroidopathy

– Posterior retinal detachment with macular hole

– Posterior retinal detachment with high myopia and posterior retinal break

– Harada’s disease

– Nanophthalmos with serous retinal detachment

– Serous retinal detachment associated with choroidal metastasis

– Serous retinal detachment associated with choroidal melanoma

• Among patients with a diagnosis of Cushing’s disease, 5% of patients have one or more episodes of documented central serous chorioretinopathy. The cases seem to occur during episodes of hypercortisolism.



General Measures

• Approximately 85% of cases demonstrate spontaneous reabsorption of the subretinal fluid within 4 months.

• Laser photocoagulation can be considered in those cases in which the subretinal fluid has not reabsorbed within 3–4 months.

– Laser photocoagulation results in reabsorption of the subretinal fluid 2 months earlier than no therapy, although the visual results are similar with treatment and without treatment in a Level A randomized, clinical trial by Robertson and Ilstrup.

– Light laser photocoagulation using 100–200 micron spot sizes can be applied to the leaking retinal pigment epithelial detachment(s).

– Follow-up by Yap and Robertson at 11–15 years disclosed that none of 6 eyes treated with laser photocoagulation had a recurrence, while 17/32 (53%) eyes that did not undergo laser therapy had at least 1 recurrence.

– Remember that the laser scars can enlarge considerably over a decade or more, resulting in late vision loss.

• In instances in which the leak is closer than 750 microns from the center of the foveal avascular zone, half fluence photodynamic therapy can be utilized.

• Intravitreal bevacizumab has also been shown to be of therapeutic benefit (Level B non-randomized clinical trial, Artunay et al.).


Surgery has not been shown to be of benefit.



• Ophthalmologist

• Low vision if vision is decreased in both eyes.

• Annual visits if stable.


• Wang et al. noted that over 90% of eyes regain vision of 20/30 or better by 6 months.

• Although most retina specialists treat leaks at the level of the retinal pigment epithelium if the serous retinal detachment is still present at 3–4 months, a long-term prospective clinical trial with Level I evidence (type 1 error <0.05, and type 2 error <0.20) does not exist.

• At 10 years, persistence of a retinal pigment epithelial detachment, persistent subretinal fluid, and recurrences resulted in a greater chance of having vision less than 20/40.


It is questionable whether laser therapy results in a higher incidence of subsequent choroidal neovascularization.


• Kitzmann AS, Pulido JS, Diehl NN, et al. The incidence of central serous chorioretinopathy in Olmsted County, Minnesota, 1980–2002. Ophthalmology 2008 Jan;115(1):169–173.

• Bouzas EA, Scott MH, Mastorakos G, et al. Central serous chorioretinopathy in endogenous hypercortisolism. Arch Ophthalmol. 1993;111:1229–1233.

• Robertson DM, Ilstrup D. Direct, indirect, and sham laser photocoagulation in the management of central serous chorioretinopathy. Am J Ophthalmol 1983;95:457–466.

• Yap EY, Robertson DM. The long-term outcome of central serous chorioretinopathy. Arch Ophthalmol 1996;114(6):689–692.

• Lim JW, Kim MU. The efficacy of intravitreal bevacizumab for idiopathic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol. 2011;249(7):969–974.

• Gemenetzi M, De Salvo G, Lotery AJ. Central serous chorioretinopathy: An update on pathogenesis and treatment. Eye (Lond). 2010;24(12):1743–1756.

• Artunay O, Yuzbasioglu E, Rasier R, et al. Intravitreal bevacizumab in treatment of idiopathic persistent central serous chorioretinopathy: A prospective, controlled clinical study. Curr Eye Res. 2010;35:91–98.

• Loo RH, Scott IU, Flynn HW Jr, et al. Factors associated with reduced visual acuity during long-term follow-up of patients with idiopathic central serous chorioretinopathy. Retina 2002;22(1):19–24.

• Wang M, Munch IC, Hasler PW, et al. Central serous chorioretinopathy. Acta Ophthalmologica 2008;86:126–145.



362.41 Central serous retinopathy


• Be certain to look at the optic nerve with slit-lamp biomicroscopy to rule out the possibility of a serous, macular retinal detachment occurring secondary to a congenital pit of the optic disc. Pits of the optic disc can be missed with indirect ophthalmoscopy.

• If any retinal blood and/or subretinal blood is present, the most probable diagnosis is choroidal neovascularization.

• Chronic central serous retinopathy may eventually lead to neovascular age-related macular degeneration years later.

• Consider early, aggressive laser therapy to the larger retinal pigment epithelial leaks seen in association with bullous central serous chorioretinopathy.

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Nov 9, 2016 | Posted by in OPHTHALMOLOGY | Comments Off on serous chorioretinopathy

Full access? Get Clinical Tree

Get Clinical Tree app for offline access