Central Serous Chorioretinopathy (CSC) is an eye condition characterized by a buildup of fluid beneath the retina, the light-sensitive tissue at the back of the eye. This fluid accumulation can lead to distorted or blurred vision, impacting clear sight. While some instances of CSC resolve without intervention, various treatment options are available for cases that persist or are more severe.
Initial Management and Observation
For many individuals experiencing acute CSC, the initial approach involves a period of watchful waiting. This observation period is based on the understanding that the body’s natural processes can often reabsorb the fluid under the retina, leading to spontaneous resolution. During this time, active treatment may not be immediately necessary as the eye works to restore balance.
A recommendation during this observation phase includes avoiding known triggers for CSC, such as corticosteroids. Regular follow-up appointments are scheduled to monitor fluid levels and vision changes, helping determine if intervention is needed.
Targeted Medical Treatments
For chronic or recurrent cases of CSC, specific oral medications may be prescribed. Mineralocorticoid receptor antagonists like eplerenone and spironolactone are common oral treatments. These medications block hormones like aldosterone and cortisol, which influence fluid balance and blood vessel permeability in the choroid, the layer of blood vessels beneath the retina.
This aims to reduce fluid leakage from the choroid into the subretinal space. Studies show eplerenone and spironolactone can improve vision and reduce subretinal fluid in patients with CSC. Potential side effects include electrolyte changes, requiring regular monitoring.
Laser and Photodynamic Therapies
If observation or oral medications are insufficient, procedural treatments like Photodynamic Therapy (PDT) and micro-pulse or subthreshold laser are considered. PDT, particularly half-dose PDT, is a common intervention for CSC, especially in chronic cases. This involves injecting a light-sensitive drug, verteporfin, into the bloodstream, which accumulates in choroidal blood vessels.
A non-thermal laser then activates the drug, closing leaky vessels and reducing fluid leakage. PDT is often guided by imaging like Indocyanine Green Angiography (ICGA) to target leaky areas. While effective, potential risks include temporary vision changes and, rarely, more serious complications.
Micro-pulse or subthreshold laser treatment uses short, repetitive pulses below the threshold of visible retinal damage. This stimulates retinal pigment epithelium (RPE) cells to pump fluid more effectively without significant thermal injury. Unlike conventional laser, subthreshold laser offers a gentler effect, suitable for leakage near central vision. This therapy has fewer side effects than PDT, but may be less effective for severe leakage.
Addressing Contributing Factors and Long-Term Outlook
Managing underlying risk factors helps prevent CSC recurrence and supports long-term eye health. Stress, Type A personality traits, and corticosteroid use are contributing factors to CSC. Addressing these factors can proactively manage the condition.
Stress reduction techniques, such as mindfulness or relaxation, can mitigate psychological stress. For those using corticosteroids, discussing alternative medications or dosage adjustments with their physician is recommended, as reducing steroid use can aid CSC resolution. The long-term outlook for CSC varies; many acute cases resolve spontaneously, but recurrence is possible. Regular follow-up eye exams monitor for new fluid or vision changes, ensuring timely intervention.