All about Central Serous Retinopathy (CSR) - Symptoms, Causes, Diagnosis, Treatment (Photo Dynamic Therapy, Retina injections, Laser treatment)

 

What causes Central Serous Retinopathy (CSR)? What are the risk factors for CSR?

 

Central Serous Retinopathy (CSR) happens when there is a break in the Retinal Pigment Epithelium (RPE). RPE is one of the several layers that makes up Retina. RPE separates the light-sensitive part of the retina from the choroid. The choroid is a layer of blood vessels that lies underneath the retina. The RPE prevents fluid and blood from the choroid building up under your retina. Due to the break in RPE, fluid begins to collect under the retina leading to swelling of the Macula. This leads to the vision becoming blurred and distorted. 

Mostly, CSR affects only one eye. It can affect both men and women. However, men between the age of 30 and 50 are more likely to develop CSR than women. The specific reasons for a person to develop CSR are not known (because of which CSR is also called idiopathic CSR). However, persons with certain traits have more chances to get CSR. There is increased possibility of CSR in the following conditions:
 

• People with a Type A personality (it refers to people who are stressed and find it hard to relax) - When people face stressful situation, the body releases a steroid called ‘Cortisol’. While the steroid ‘Cortisol’ is good since it helps to cope with stress, however in people with Type A personality, level of Cortisol’ can be much higher causing issues e.g. reduction in ability of the human immune system (which helps the human body fight with any infection), and increased fragility and permeability of blood vessels

• People who use steroid medication

• Women during the duration of their pregnancy

• People with Cushing Syndrome (Cushing Syndrome sometimes called hypercortisolism occurs when the body is exposed to high levels of the steroid hormone cortisol for a long time. The condition can occur when the body makes too much cortisol on its own or may be caused by the use of oral corticosteroid medication. According to one study ~5% of people with Cushing syndrome are expected to have CSR)

• Helicobacter pylori infection (it is a type of bacteria that can infect the stomach)

• Autoimmune disease (it is condition when the body attacks its own tissues)

• Sleep disturbances like insomnia (i.e., when someone is having trouble falling asleep or staying asleep) or sleep apnea (when breathing is interrupted during sleep

• Hypertension (High blood pressure)

• MPGN type II kidney disease

• Genetic tendencies (in one of the studies, it was determined that about 50% of the CSR patients had at least one relative with the findings of CSR. However, the study also goes on to claim that no specific inheritance patterns have been observed)

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How is Central Serous Retinopathy (CSR) diagnosed by an Ophthalmologist?

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The eye specialist will use specialised equipment such as Slit lamp and Indirect Ophthalmoscope to examine the patient’s eye focusing on the retina and the macula. The doctor shall administer dilating eye drops to the patient’s eyes about 30 minutes prior to examination. The dilating eye drops help in pupil dilation (i.e. to widen / stretch the pupils in the eye). The dilated pupil shall help the doctor to analyse the retina and macula in a better and easy way. The effect of the eye drop may take 4 to 6 hours to wear off completely.
 

Based on the diagnosis, the doctor may want to conduct further tests for reconfirming the initial diagnosis and to establish the extent of the disease 

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• Optical Coherence Topography (OCT) - It is a quick, non-touch, non-invasive and painless imaging method. During OCT, a scan of the affected eye is conducted by asking the patient to look into a source of light for a particular duration of time. The scan provides a cross sectional view of the various layers of the retina and a comprehensive view of the macula. This enables the doctor to determine the amount of fluid deposited in the macula and establish the level of swelling of the macula.

 

• Fundus Fluorescein Angiography (FFA or FA) - In FFA, photos/ images are taken of the network of bloods vessels which are under the retina. This enables the doctor to determine the leakages. It often takes less than 30 minutes. The procedure is as follows:

  • Your eye doctor or an assistant will put drops in the eyes to dilate (widen) the pupil.

  • A yellowish coloured dye (fluorescein) is injected in a vein, usually in the arm. It takes about 10–15 seconds for the dye to travel throughout the body. While this is painless, some people may feel sick. The dye eventually reaches the blood vessels in the eye, which causes them to “fluoresce” or shine brightly.

  • As the dye passes through the retina, a special fundus camera takes pictures. This enables the doctor to determine the leakages. The angiography will reveal fluorescent spots with fluid leakage

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