Central Serous Chorioretinopathy in Jacksonville, Florida
Central serous chorioretinopathy is a collection of fluid under the retina at the macula. It blurs and dims central vision, makes objects look smaller or further away, and in most people it resolves on its own within a few months. The judgement is in knowing when to wait and when not to.
What happens
Fluid leaks from the choroid — the blood-vessel layer beneath the retina — through the retinal pigment epithelium and collects under the macula, lifting it slightly off its normal position. That small elevation is enough to distort and dim central vision.
It is most common in adults in their thirties to fifties and considerably more common in men. It is usually one eye at a time, though the fellow eye often shows subtle changes.
Symptoms
- A blurred or dim patch in the centre of vision, often described as looking through a smudge
- Objects appearing smaller in the affected eye
- Straight lines bending
- Colours looking washed out or dimmer
- Needing more light to read, or a slight prescription shift toward farsightedness
Vision is rarely lost outright. It is degraded in a way that is easy to dismiss and frustrating to live with.
Risk factors — and the one that matters most
Corticosteroids. This is the strongest and most consistent association, with roughly a fourfold increase in risk overall. The evidence is clearest for oral, injected, and nasal steroids. For inhaled steroids the pooled evidence is weaker and has not reached statistical significance, so an asthma inhaler is not something to stop over this. Topical skin steroids and joint injections have been implicated in case reports.
The practical instruction: if you have central serous chorioretinopathy, tell every physician you see about it — dermatologist, rheumatologist, orthopaedist, primary care — because steroid by any route may be relevant. And do not stop a prescribed steroid on your own. Bring it to the prescriber, and we are glad to be part of that conversation.
Also associated: psychological stress and type-A personality patterns, sleep disturbance including obstructive sleep apnoea, pregnancy, Helicobacter pylori infection, and untreated high blood pressure. Stress is not a fringe theory here — it is one of the better-established associations, which is why stress reduction and sleep are a real part of the conversation rather than a platitude.
Diagnosis
Diagnosis is made on optical coherence tomography, which shows the fluid under the retina directly and measures it. We also use fluorescein angiography to find the leak point and OCT angiography to check for choroidal neovascularisation, which can complicate long-standing cases and changes the treatment entirely.
The diagnosis matters because central serous is frequently mistaken for wet macular degeneration, and treating one as the other is a real error — a patient with central serous who is started on injections has been given the wrong treatment. More about our imaging and diagnostic testing.
Treatment
Observation, and what it is for
Between 84 and 100 percent of acute episodes resolve on their own, usually within three to four months. So the first step in an acute, first-episode case is generally to watch, remove what we can — steroid exposure, stress, poor sleep — and rescan.
Observation is not doing nothing. It is a deliberate choice with a defined endpoint. If the fluid persists beyond about three months, or if vision is dropping, the calculation changes, because chronic fluid damages the photoreceptors above it and that damage is not fully recoverable.
Photodynamic therapy
Half-dose or half-fluence photodynamic therapy is the treatment of choice for persistent disease, and it is the one with the strongest randomised evidence. In the PLACE trial, comparing it head to head against subthreshold micropulse laser in chronic cases, PDT achieved complete fluid resolution in 67 percent of eyes at final evaluation against 29 percent, with better visual acuity and better retinal sensitivity.
Laser
Subthreshold micropulse laser is a reasonable alternative, particularly where photodynamic therapy is not available. It was inferior to half-dose PDT in the direct comparison, and long-term outcome data are thinner.
Conventional focal laser to a leak point away from the centre of the macula still has a place in selected cases.
Oral medication
Oral mineralocorticoid antagonists — eplerenone and spironolactone — were widely used for chronic central serous for several years. The randomised evidence did not support them. The VICI trial, a placebo-controlled trial in 114 patients with chronic disease, found no improvement in vision at 12 months, and no improvement in fluid resolution or recurrence. A separate trial comparing eplerenone against half-dose photodynamic therapy found 17 percent fluid resolution against 78 percent.
We tell you this because you may have read about these drugs, or been offered them elsewhere. If oral treatment is part of your plan, we will explain specifically why in your case.
Anti-VEGF injections
Not a treatment for central serous itself. They are used when long-standing disease has been complicated by choroidal neovascularisation — abnormal new vessel growth — which is why we look for it on angiography.
What to expect
Most first episodes resolve with good vision. Recurrence happens in roughly a third of patients, sometimes more, so a first episode is a reason to know the symptoms rather than to assume it is finished.
Chronic disease, where fluid persists for many months or recurs repeatedly, is the form that costs vision — through gradual thinning of the photoreceptors and atrophy of the pigment layer. That is the case for not letting fluid sit indefinitely.
Questions patients ask
Will my vision come back?
In most acute episodes, yes, largely. Some patients are left with a subtle loss of contrast or colour richness even after the fluid clears. Longer-standing fluid leaves more behind.
Is this caused by stress?
Stress is one of the better-established associations, and so is disturbed sleep. That does not mean stress alone caused it or that you brought it on yourself. It does mean that addressing sleep and stress is a legitimate part of managing it.
Should I stop my steroid medication?
Do not stop any prescribed medication on your own. Tell us and tell the prescriber. Some steroids can be reduced, switched, or replaced; some are treating something more important than this. That is a decision to make together.
Will it come back?
Around a third of patients have a recurrence. If the blur or distortion returns, call us rather than waiting to see whether it settles.
Should I be taking eplerenone?
The randomised evidence says it does not help chronic central serous. If it has been suggested to you, ask why in your particular case.
Getting seen
We accept urgent referrals and see urgent cases within 24 hours. Call (904) 666-5050. Our office is open 8:00 am to 5:00 pm, Monday to Friday, at 3627 University Blvd S, Suite 605, Jacksonville, FL 32216. Our staff speak English, Arabic, and French.
Dr. Elkeeb operates at HCA Florida Memorial Hospital and Baptist Medical Center Jacksonville.
Referring physicians and optometrists: our referral information is here.
Sources: EyeWiki, Central Serous Chorioretinopathy (American Academy of Ophthalmology); van Rijssen TJ et al., PLACE trial, Ophthalmology 2018;125:1547–55; Lotery A et al., VICI trial, The Lancet 2020 and NIHR Health Technology Assessment 2021; meta-analysis of corticosteroid exposure and central serous chorioretinopathy, Graefe's Archive for Clinical and Experimental Ophthalmology 2019; review of current management, Eye 2025.
This page is general information about a medical condition and is not a substitute for examination and advice from your own physician. Do not start, stop, or change any medication based on what you read here.