Examqo › Examqo library › Ophthalmology › Retina and macula · IMLE
Central serous chorioretinopathy (CSC)
In CSC fluid from a thick hyperpermeable choroid (pachychoroid) leaks through an RPE defect and lifts the sensory retina at the macula; most acute cases resolve on their own within a few months, the first step is stopping steroids in any form, and chronic CSC is treated with half-dose PDT.
Why it matters in the exam
The exam picture: a man aged 30–50, under stress, with blurred vision in one eye, distortion of lines, objects looking smaller than usual (micropsia) and a slight hyperopic shift. On OCT: subretinal fluid with a thick choroid, sometimes a small RPE detachment. On fluorescein angiography: a leakage point that spreads like a "smokestack" or an ink blot. The most important factor: steroids — oral, inhaled, nasal, skin or injected — even at small doses; also stress, type A personality, pregnancy, Cushing syndrome and sleep apnoea.
In most patients the fluid resolves within 3–4 months and vision returns, but recurrences are common. Chronic CSC — fluid for more than 3–6 months or many recurrences — causes RPE atrophy and permanent loss of vision, and sometimes new vessels. The PLACE trial showed half-dose verteporfin PDT to be better than micropulse laser. The VICI trial showed eplerenone to be ineffective in chronic CSC, although it had been widely used. A leak far from the centre can be sealed with focal thermal laser.
The differential diagnosis matters: new vessels (MNV) in an older patient — OCT-A and angiography; VKH — bilateral with inflammation; optic disc pit — fluid that connects to the disc; a choroidal tumour. In a patient with CSC who takes a steroid for an important medical reason — coordinate the decision with the treating physician and do not stop it abruptly. Ask explicitly about inhalers, nasal sprays, skin creams and joint injections, because many patients do not think of them as "steroids".
Key points
- Subretinal fluid from a thick choroid through an RPE defect.
- Young man, stress, steroids.
- Smokestack on angiography.
- Most cases resolve within 3–4 months.
- Chronic → half-dose PDT; eplerenone ineffective.
Summary table
| Condition | Finding | Approach |
|---|---|---|
| Acute CSC | Subretinal fluid, "smokestack" leak | Stop steroids and follow up for 3–4 months |
| Chronic CSC | Fluid beyond 3–6 months, RPE atrophy | Half-dose PDT |
| Leak far from the centre | Single leak outside the fovea | Focal thermal laser |
| Secondary MNV | New vessels on OCT-A | Anti-VEGF |
| Patient on steroids | Exposure from any source | Coordinated reduction with the treating physician |
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
- Enough for IMLE
The full version is open to subscribers of: Ophthalmology, Medical licensing exam (IMLE).
Subscriber? Read the full topic Plans and prices 25 free questions
Sources
- VICI Trial: Eplerenone for chronic central serous chorioretinopathy, 2020 — Results
- PLACE Trial: Half-dose photodynamic therapy versus high-density subthreshold micropulse laser for chronic CSC, 2018 — Results
- AAO Basic and Clinical Science Course, Section 12: Retina and Vitreous, 2024-2025 — Central serous chorioretinopathy
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.