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Central Serous Retinopathy : Questions


Thank you for reading my message.

I had blurry vision in my right eye for the past few months. Had my yearly eye exam on Monday and the OCT showed pigment epithelial detachment. Was referred to a Retinal Specialist who I saw today. He did a fluorescence angiography and gave me a diagnosis of Central Serous Retinopathy. I have been prescribed Spironolactone for 6 weeks (once per day for 3 days and 2 per day after that) and will see him again after that. I have summarized the Retinal Specialist's comments during my visit today as below :

1) There is a 65 % chance of recovery after the medication.

2) He recommended against wait and watch and said if there is no improvement or the fluid accumulation under the retina gets worse after 6 weeks of Spironolactone, laser treatments will have to be done.

3) The blurriness in the right eye might take time to resolve or will probably never resolve to 20/20 vision like I previously had.

4) There is a chance of recurrence in both eyes. He said excessive stress is a trigger and the condition is inherited.

1) Has anyone received treatment for CSR? What was your response?

2) I would be grateful for any comments or advice on managing CSR.

Thank you
2 Responses
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Avatar universal
Got it. Thank you again, Dr Hagan!
Helpful - 0
233488 tn?1310693103
The retina surgeon was 'dead on" in what you were told about the condition, treatment and diagnosis. I have had patients recover 20/20 vision after CSR.
Helpful - 0
Hello Dr Hagan,

Thank you so much for your answer!  Other than taking  the prescribed Spironolactone, would you advise anything else I can do to increase my chances of  recovering with 20/20 vision and avoid a future recurrence?

Thank you
The link to stress is suspect so try and keep your pressures under control. The problem is more common in young males than females. Keep close contact with your retina surgeon
Thank you again for your helpful answers!
Blessings your way
Blessings your way
Hello Dr Hagan,

I hope you are doing well. Thank you again for your valuable replies.

I will be seeing the Retinal Specialist (RS) on Thursday after 6 weeks of Spironolactone (once per day for 3 days and 2 per day after that). My right eye blurriness has not improved in any significant manner. It has not gotten worse either. The RS told me that it takes time to regain vision even if the retinal fluid leakage has stopped. I have been exercising with weights three times per week and keeping my stress levels low.

1) Does the persistence of right eye blurriness mean that CSR is progressing?

2) If CSR is progressing,  is it advisable to opt for laser treatment right away?

3) Is  there any difference in outcomes between thermal laser treatments and photodynamic  therapy? What are the risks?

Thank you

I may mean that the pill has not had enough time to work.  Laser is never an emergency for CSR. The surgeon will have to advise based on their success and skills best of luck
Hello Dr Hagan,

Thank you so much again for your reply! I am very grateful.

Best of  luck. A very close friend of mine, a surgeon has CSR so I have followed developments closely. My friend has done well. He took, may still be taking, spironolactone and did not have to have laser.
That's great to hear! Thank you.
Hello Dr Hagan,

Just an update :  Had my visit yesterday. OCT showed a 30% decrease in the  fluid. The Retina Specialist will see me again in six weeks. He said I might have to be take Spironolactone for up to six months and may be able to avoid laser therapy if the response continues to be good, which was exactly your answer. If you have any other comments, I am eager to hear. Thank you!
Fabulous news. Chances are good over time the rest of the fluid will reabsorb.
Thank you, Dr.Hagan!  Your answers provided a lot of clarity for me.  Thank you for your time.
You  are welcome
Hello Dr. Hagan,

I hope you are doing well. If you don't mind, I have a question:

Since the last week of June, I started training with 20 lbs dumbbells' at home three times per week. I feel good, but my sex drive is considerably lower compared to before I started on Spironolactone. I certainly want to get better when it comes to CSR and will continue taking Spironolactone and  also work with dumbbells. '

1) Is this a common side effect?
2) Will the sex drive return after I stop  Spironolactone at a future time?
2) Any advice from you on increasing my sex drive when taking Spironolactone?

I have asked the same question to  my Retina Specialist as well. Just thought of asking you as well.

Thank you
I never mind saying "I don't know" and that is what I'm saying. I don't use that medication. In our patients with CSR, I refer then to the two retina MDs in our practice. You would have to ask your prescribing physician.
Hello Dr Hagan,

I hope you are doing well!  I want to thank you again for your generous replies during June-August 2021 regarding my questions about CSR! If you don't mind, I have a few new updates that has me worried. I have the updates below and my questions are described after the updates:

1) Between August 2o21 through March 2022, my vision got better and returned to 20/20.  The Retinal Specialist (RS) was pleased with my progress and asked me to continue Spironolactone twice per day.

2) In March 2022, I noticed a bit of blurriness in my right eye. I saw the RS right away. Although the vision in my left eye was 20/20, I could read only half the letters in the last row of the eye exam with my right eye. After looking at my OCT results, he told me that right eye has slightly deteriorated. He asked about my sleeping habits. For the last few years, I have been sleeping 4 hours every night and I come home from work around 4 pm and sleep 4 hours again. He did not think that was a big issue but asked me to take melatonin if I have trouble sleeping. My sleep cycle is a habit and I have no trouble falling asleep.  I continued my usual sleep cycle of 4 hours at night and 4 hours after I return from work in the evening.  I was asked to see him after two months.  My eye pressures were normal.

3) Last week, I noticed the blurry vision in my right eye got worse and I was getting eye strain in my right eye lid when I work on the computer. The eye strain is also sometimes felt in the left eyelid as well.  I saw the RS today. Although the vision in my left eye was 20/20, I could read only a few letters in the last row of the eye exam with my right eye.  The OCT revealed a new finding which the RS suspects might be new blood vessels growing on the retina and he advised an Indocyanine Green Angiography to find out if I have Wet Macular Degeneration or other serious eye conditions that might impact my central vision. I am getting the ICG done on Thursday. The RS told me that approximately 15 % of CSR progresses to Wet Macular Degeneration and I will only know the precise diagnosis after the ICG test results. My eye pressures were normal.

My diet/exercise:
My diet is vegan and clean. I am 5 ft 8, 136 lbs., 33 inches waist. I work out upper and lower body with 15 through 30 lb. dumbbells twice per week.  I do 10-minute HIIT cardio sessions 2-3 times per week.


1) Is it very likely that I have Wet Macular Degeneration? Is my sleep cycle the main reason for my new symptoms and the worse results on the OCT today? Is this a treatable condition where I could maintain my central vision?

2) What other serious eye diseases I might have? Worried about retinal cancer etc.

3) Is there any chance that  this might be a stronger version of CSR which will probably respond to medication and me sleeping 7-8 hours every night? You had explained to me in your earlier posts about stress hormones being a trigger for CSR. Therefore, I was wondering if fixing my sleep cycle would help in any way?

Sorry for the long message.  

Thank you!!

As far as the relationship of CSR to sleep, diet, stress, I don't think there are any really good studies.   Choroidal neovascularization (NV)  is a much bigger threat to your central vision than the CSR. If the angiogram does shoe NV there are good treatments which usally involve injection VEGF inhibitors like Avastin or Lucentis into the center of the eye. This causes the vessels to regress but it takes a lot of injections over a long period of time to get the NV to 'dry up"  The most common eye cancer primary is a melanoma, they are rare and not worth worrying about, the most common tumor in the eye is a metastatic cancer from breast in women and lungs in men. I think it not a concern.  I don't think your sleep patterns will have any effect on NV and likely not CSR fluid. Best of luck
Thank you so much for the answer, Dr Hagan!   If you don't mind, just a few more questions:

1) Are the findings in OCT enough to conclude I have NV and the angiography is more of a confirmatory test for what is clearly seen as NV on the OCT?
2) Are there other eye diseases that have NV other than Wet Macular Degeneration?  Are they all as serious as Wet Macular Degeneration?
3)  I am 46. Does Choroidal neovascularization happen at any age? Is this just a random thing?  Just wondering if I triggered it in some way.

Thank you!!
1. The angiogram is the gold sandard for definative Dx, other things on OCT that are not NV can look like NV on OCT
2. There are a long list of diseases that can cause NV including vein or artery blockages, diabetic retinopaty, histoplasmosis, etc
3. CV is much more common in oldeer patients and is associated with exudative "wet" age related macular degeneration.  Your lifestyle contains no triggers that you posted
Hello Dr Hagan,

Thanks a lot again for your answers!! That was very helpful. If you don't mind, I will update you after completing my  Indocyanine Green Angiography today.

That would be fine.
Hello Dr Hagan,

Thank you! Following are the updates after my ICG test and consultation with the Retinal Specialist(RS):

1) The test revealed the growth of a tiny, blood vessel in the right eye as seen on ICG.
2) The RS told me that the NV was due to CSR and not Wet Macular Degeneration.
3) I was given an injection that was a combination of two VGEF inhibitors or it was a combination of a VGEF inhibitor and some other medication. I did not catch that completely.  I am sure one of the medications was Avastin which would stop the blood vessel from growing further and hopefully  dry up the vessel as you had explained it to me. I was told its a new treatment with more promise than injecting just a single VGEF inhibitor.
4) I will be taking monthly injections for three months and then tested again.
5) The frequency of injections will change depending on my response.
6) The care for this condition will last around two years or more.

1) Is NV for CSR any better than NV for Wet MD?  Does it have a better chance of recovery?
2) I would be grateful for your comments or any advice.

Thank you!

By definition when blood vessels grow from choroid into retina it is called "exudative macular degeneration" the most common cause is age, many other causes CSR, blockage of retinal veins, histoplasmosis, high myopia.  The prognosis cannot be predicated as these are very unique cases.  Wet MD treatment has improved dramatically since Avastin, Lucentis, Eylea and other VEGF inhibitors have been develeoped. Goodluck
Thank you for your time and answers, Dr Hagan!!
You are welcome, bes tof luck

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