CENTRAL SEROUS CHORIORETINOPATHY

Ophthalmologist Carolina Valdivia, MD discusses the condition Central Serous Chorioretinopathy with a reader that has been experiencing black rings in his field of vision.

Dear Dr. Valdivia,

What are the symptoms of Glaucoma? I am getting black rings before my left eye and a feeling of lightning from top to down when my eyelid closes. I currently am taking Diclofenac eye drops for this problem and Telista for hypertension. My doctor has advised me that if after of one month of using the Diclofenac the problem does not improve, I should see a retina specialist. What is going on with my eye?

Let's first review the elements of your case.

• You are experiencing eye discomfort.
• You are seeing black rings in your central vision.
• Your doctor has prescribed a treatment (Diclofenac).
• Your doctor has advised you to see a retinal specialist if improvement does not occur after one month of Diclofenac use.

Taking these factors into consideration, it is likely that you are suffering from a condition called Central Serous Chorioretinopathy (CSCR).

CSCR is a sporadic condition that generally is self-limiting. This means that its incidence in populations does not follow any recognizable pattern, such as a family history, and it usually follows a temporary course. It is 6-10 times more prevalent in men aged 20-55 years than in women.

Cross-section through the fundus of the eye, showing the retina (R), sclera (S), and the choroid (C) middle layer.

Central Serous Chorioretinopathy is characterized by the accumulation of fluid under the macula, an area of the retina that is responsible for central vision. The fluid leaks in from the choroid layer and causes a defined area of retinal detachment. As the figure shows, the choroid is a layer of tissue located between the sclera and the retina. The choroid serves as the main supply of blood and nutrients for the eye.

CSCR can result in distorted vision (metamorphopsia) or an alteration of the perception of object size. For example, a person may perceive a straight line to be twisted. Other problems include a blind or gray spot in the central vision (visual obscurations), flashes of light (photopsia), and impaired color vision.

The exact cause of Central Serous Chorioretinopathy remains unknown. However, most cases appear to be linked in some way to stress. Patients with type A personalities, hypertension, systemic lupus erythematosus, and obstructive sleep apnea have reported CSCR episodes. The disease progression is believed to be mediated through elevated circulating cortisol and epinephrine, which influence the regulation of circulation in the choroid. Cortisol is a hormone secreted by the adrenal gland that helps the body to deal with stress.

Central Serous Chorioretinopathy, showing retinal detachment (arrows) with fluid accumulation. [Top] Optical Coherence Tomography image. [Bottom left] Fluorescein angiography image.

Episodes of CSCR also have been associated with Helicobacter pylori infection, which is a cause of gastritis. Although visual acuity and central vision problems have been correlated with attacks caused by these bacteria, the mechanism behind them is not well understood.



A retinal detachment caused by CSCR usually resolves by itself, with a majority of patients (80-90%) returning to 20/25 or better vision. However, despite the return of good central vision, some patients continue to report incidences of distorted vision and/or problems with color vision. Generally, patients with Central Serous Chorioretinopathy have a 40-50% risk of recurrence in the same eye and are more prone to experiencing a retinal detachment.

Treatment usually consists of using a non-corticosteroid anti-inflammatory agent, such as the Diclofenac eye drops that you have been prescribed. Control of blood pressure also is recommended, along with various strategies to reduce stress. A retinal specialist may consider the use of laser surgery if the problem persists, recurs frequently, or if there is neovascularization (proliferation of new, but weak blood vessels) in the area of retinal detachment.

You asked about glaucoma. From your description, it is unlikely that you have it. Glaucoma affects the optic nerve, not the macula. However, if you are interested, I suggest that you read about the symptoms of glaucoma and diagnosis of glaucoma and then have a discussion with your ophthalmologist about that possibility the you also might be developing glaucoma.

Remember, the Diclofenac eye drops that you are taking are designed to reduce inflammation and help with any discomfort that you are experiencing. Take your doctor's advice. If your symptoms do not improve within one month, see a retinal specialist.

Carolina Valdivia, MD

REFERENCE:

Tsai JC, Denniston AKO, Murray PI, Huang JJ, and Aldad TS. Oxford American Handbook of Ophthalmology. New York: Oxford University Press, 2011:426-428.

Return from Central Serous Chorioretinopathy to Answer My Health Question