• A Chorioretinal disorder characterized by an idiopathic localized serous detachment of the neural retina in the macular region.
• Usually unilateral

Etiology

• Age: 20 – 50 years
• Gender: Male > female
• Increased incidence in:
• Emotional stress
• Type A personality
• Physical Strains
• People engaged in visually demanding work
• Also found to be associated with vasoconstrictive agents, endogenous hypercortisolism, Systemic corticosteroids, SLE, Hypertension

Ophthalmic Features

• Presentation:
• Unilateral blurred vision with a relative scotoma in the central visual field
• Unilateral metamorphopsia and/or micropsia
• Patients with extrafoveal involvement may be asymptomatic
• Visual acuity:
• V/A ranges from 6/5 to 6/60, usually 6/9 – 6/12
• Acquired hyperopia
• Disparity between retinoscopy and refraction



• Fundus:
• A round to oval sensory retinal detachment is present at the posterior pole
• SRF: clear or turbid ± Precipitates in the posterior surface of the sensory detachment
• In some small PED within the serous detachment may be evident
• Other features:
• Impaired Dark adaptation
• Colour desaturation
• Increased retinal recovery time to bright light
• Patients may present as bullous inferior peripheral retinal detachment (non-rhegmatogenous), with a tract of atrophic RPE from macular region (seen best with FFA)

Investigations

• Fundus Fluorescein Angiography (FFA)
• Slit Lamp Biomicroscopy
• Optical Coherence Tomography ( OCT)

FFA

• Characteristic features:
• Smoke-stack appearance:
• Small hyperfluorescent spot in the early phase due to leakage of dye through the RPE
• Fluorescein passes into the subretinal space and ascends vertically until the upper border, like a smoke-stack, in the late venous phase
• The dye then spreads laterally, taking on a “mushroom” or “umbrella” configuration until entire area of detachment is filled
• Ink-blot appearance: less common
• Hyperfluorescent spot in early phase , which enlarges centrifugally until the entire detachment is filled with dye

Smoke stack appearance

Ink blot appearance

Slit Lamp Biomicroscopy

• Transparent blister in the posterior pole between neural retina and RPE
• Beam splitting as the light traverses the serous space
• Increased distance between the retinal vessels and their shadows
• Absent foveal reflex
• Small dot like deposits in the posterior of retina which is believed to be the precipitates of plasma proteins including fibrin

OCT
Can be used to quantify the amount and extent of subretinal fluid
            

Treatment

• Observation: 3-4 months in most first episodes of unilateral CSCR
• Laser photocoagulation
• Systemic beta blockers: may have a beneficial role, but not well proven