Central scotoma, blurred or dim vision, objects may appear distorted (metamorphopsia) and miniaturized (micropsia), colors may appear faded. Usually unilateral, but can be bilateral (more likely in older patients, may not be symptomatic at the same time). May be asymptomatic.

(See Figure 11.15.1.)

These entities may produce a serous detachment of the neurosensory retina in the macula

• AMD: Patient usually ≥50 years old, drusen, pigment epithelial alterations, may have choroidal (subretinal) neovascularization, often bilateral. See 11.16, NONEXUDATIVE (DRY) AGE-RELATED MACULAR DEGENERATION and 11.17, NEOVASCULAR OR EXUDATIVE (WET) AGE-RELATED MACULAR DEGENERATION.
• Optic pit: The optic disc has a small defect (a pit) in the nerve tissue. A serous RD may be present, contiguous with the optic disc. See 11.34, OPTIC PIT.
• Macular detachment as a result of an RRD or macular hole: In RRD, a hole in the retina can be found. See 11.3, RETINAL DETACHMENT and 11.25, VITREOMACULAR ADHESION (VMA)/VITREOMACULAR TRACTION (VMT)/MACULAR HOLE.
• Choroidal tumor, particularly choroidal hemangioma: See 11.36, CHOROIDAL NEVUS AND MALIGNANT MELANOMA OF THE CHOROID.
• Hypertension: See 11.10, HYPERTENSIVE RETINOPATHY.
• Pigment epithelial detachment (PED): The margins of a PED are more distinct than those of CSCR, and the RPE is elevated. Occasionally, PED may accompany CSCR or AMD.
• Others: Idiopathic choroidal effusion, inflammatory choroidal disorders, and chronic renal failure.

• Idiopathic: Most common in young adult to middle-aged men. In women, CSCR has an association with pregnancy. Increased incidence in patients with lupus.
• Increased endogenous cortisol: This might explain a possible association with psychological or physiologic stress (type A personality). Rare cases exist with cortisol producing adrenal adenomas or Cushing syndrome.
• Exogenous cortisol: Corticosteroid use, including nasal corticosteroid sprays and topical creams.

1. Observation: Acute CSCR is usually self-limited with good visual prognosis. Worse prognosis for patients with recurrent disease, multiple areas of detachment, or prolonged course.
2. Stop corticosteroids, if possible, including topical skin and nasal spray preparations.
3. Laser photocoagulation: May accelerate visual recovery, but long-term benefit and safety are unclear. May increase risk of CNV formation. Given the CNV risk, use low laser intensity. Consider laser for:
   • Persistence of a serous detachment for several months.
   • Recurrence of the condition in an eye that sustained a permanent visual deficit from a previous episode.
   • Occurrence in the contralateral eye after a permanent visual deficit resulted from a previous episode.
   • Patient requires prompt restoration of vision (e.g., occupational necessity).
4. Photodynamic therapy (PDT): May be helpful for chronic CSCR. Half-dose PDT may be considered for rapid SRF resolution in patients with acute CSCR.
5. Mineralocorticoid receptor antagonists: Eplerenone and spironolactone have been associated with improved anatomic and visual outcomes in chronic CSCR.
6. If CNV develops, consider anti-VEGF therapy.

1. Examine patients every 6 to 8 weeks until resolution.