CSC occurs primarily in persons between the ages of 35 and 55 years, with a male-female ratio of 3:1; at present there are no reliable statistics suggesting any association with race. Patients describe a variety of symptoms, including sudden onset of blurred or dim vision, micropsia, metamorphopsia, paracentral scotomas, decreased color vision, and prolonged afterimages. Visual acuity ranges from 20/20 to 20/200, but in most patients, it is better than 20/30. Decreased visual acuity can often be improved with a small hyperopic correction. CSC can show several clinical variations in its expressions. In an acute manifestation, the retina has a round or oval elevation in the macular region; it often involves the fovea. Fluorescein angiography shows leaks from the RPE that may appear, early in the angiographic sequence, as a dot (the “dot” form) or as a tree-shaped movement of dye in the subretinal space (the “smokestack” form) (Fig 9-1). In some circumstances, vigorous leaks can cause deposition of a grayish white, feathered-edge subretinal material that is generally believed to be fibrin. In chronic CSC, the RPE shows granular pigmentation; fluorescein angiography reveals many small, sometimes inconspicuous leaks; and there is widespread shallow detachment with areas of atrophy of the photoreceptors (see Fig 9-1).
Figure 9-1 Fluorescein angiographic forms of the leaks in central serous chorioretinopathy (CSC). A, In the early phase, the patient was seen to have 2 main leaks. B, Later in the angiogram, the leaks show two different morphologies; the smokestack and the dot varieties. C, Acute CSC generally presents as 1 or up to a few leaks. D, Chronic forms of CSC exhibit many small leaks.
(Courtesy of Richard F. Spaide, MD.)
As mentioned, CSC is associated with stress and with a tense, driven personality. Systemic associations include endogenous hypercortisolism (Cushing syndrome), hypertension, sleep apnea, use of psychopharmacologic medications, and pregnancy. Use of systemic corticosteroids is associated with CSC, but curiously, use of intraocular corticosteroids does not appear to be associated with the condition.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.