What is Central Serous Chorioretinopathy?

Central Serous Chorioretinopathy (CSR) is a retinal detachment that causes blurry vision, light sensitivity – and can lead to nausea and headaches. 

When this happened to me, I woke up one day and couldn’t see clearly.  I thought my eyes were just tired – that I was working on my computer too much. 

But after three days, I booked an optometrist appointment. As a medical professional myself, I’m not complacent with my health. When they showed me an amsler grid, it looked like this. I felt woozy. 

What was happening to me? Why did I feel like I was seeing underwater?

Well, here it is simply: In CSR, two things are happening.

1. Your eye vessels become damaged and leak fluid. 
2. This fluid accumulates behind your retina – causing it to detach, leading to blurry vision.

The retina is in the back of your eyeball and it has a bowl shape to it. When fluid accumulates behind it, it forms an irregularity (or bump, if you will) under this usually smooth bowl-like shape. 

That’s why everything looks wonky. It’s like looking through a funhouse mirror…in one eye.

It’s not simply blurry vision, straight lines look wavy. One of my patients put it as:  “everything is a Frank Gehry building!”. 

When both eyes are open your brain contends with one normal eye and one misshapen one interpreting them together as blurriness.

For me, this disorientation caused other problems too. I felt nauseous, I fatigued easily, keeping my eyes open too long led to lightheadedness. 

Wearing sunglasses inside helped my symptoms so I started doing that. I couldn’t see properly while driving so I drove with an eye patch…but I did not have good depth perception. 

But what was I supposed to do? CSR lasts months – and we still need to work, take care of ourselves and others. I was 8 months pregnant, trying to wrap up work and prep for a new child. Life could not stop.

Central Serous Retinopathy Prognosis

Most of the time it self-resolves, sometimes it does not. 

Sometimes it goes away forever, and sometimes it comes back (half of cases return). The conventional treatment for CSR can also cause vision loss. Great, great, great.

As someone who helps people with CSR now, I’ve discovered that what makes a big difference is how you respond to it. 

Do you address the root problem? 

Do you keep doing things that triggered it?

Or do you continue to ignore them?

We’re going to talk about this in-depth. But if you need help auditing your root causes right away, I’m here to help. Book a 15 min meet and greet.

The Cortisol Connection

CSR is caused by high cortisol. This can be from cortisone medications and creams – or your own high cortisol production. 

High cortisol attacks the vessels behind your eye, causing fluid and the detachment.

Personally, mine was caused in my third trimester of pregnancy (a time of increased cortisol). But it was my high stress life that increased my baseline cortisol, making me more vulnerable to CSR.

Some of my patients report that CSR returns during stressful times. Even years later. 

This is also why I find it crucial to keep your cortisol low even if CSR resolves. While cure is always a goal – maintenance and prevention are essential.

Regular Treatment can cause Permanent Damage.

If you are using cortisone cream or taking cortisone-based medications, speak to your doctor about stopping or switching them. But you cannot ignore your own natural production of cortisol (more on that soon).

Besides stopping cortisone meds, the standard treatment for CSR is to wait… and hope that it clears up on it’s own.

Usually, an ophthalmologist will recommend waiting for 4 months. If CSR doesn’t resolve itself, the next step is laser surgery.

The big problem is that this procedure can cause other vision problems.

The aim of the surgery is to coagulate and seal up your leaky, damaged eye. However there’s a significant risk of scarring your retina. 

This is no secret. Every Optometrists and ophthalmologists I have ever spoken to has been clear that this scarring risks causing irreversible vision damage. 

Most have admitted that it’s not a treatment they like but that there aren’t others available. Yikes.

Natural Treatments

The likelihood of self-resolving is good. Up to 80% get better but that means up to 20% do not resolve and are considered chronic, non-resolvable CSR. https://emedicine.medscape.com/article/1227025-overview?form=fpf#a6 

Of those who do improve, 5-10% regain their visual acuity but do not to a full degree. https://emedicine.medscape.com/article/1227025-overview?form=fpf#a6 

And around half of those with CSR find they get a recurrence later on. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6897067/ 

For me, I wanted to do everything I could to not be that 20% who did not resolve. 

My vision loss made me feel powerless and disabled. So I did everything I could to increase my chances of self-resolving. 

When the Optometrist diagnosed me, I could not simply wait and cross my fingers. That’s probably a trait for people prone to CSR. High-stress, high cortisol people don’t tend to take bad news with lots of chill.

He referred me to a hospital Ophthalmologist who was not booking out for more than a month. It seemed forever. For someone who can’t see properly, each day was a struggle. 

And when I got to see them, it was explained that they would simply confirm my diagnosis and monitor for the need for surgery.

I decided I needed to go beyond the regular system.

My Natural Treatments

I decided to do everything I could to support my recovery. I think 6/7 days a week I was seeing a different health practitioner for this. I made a budget just for CSR care. I saw:

• Two chiros
• Two cranios 
• An acupuncturist 

…all weekly to encourage local drainage and encourage circulation. 

I ate a low cortisol, blood sugar stabilizing diet. I took eye health nutrients and botanical herbs. I restarted psychotherapy. Some of these made more improvements than others. But during it all I learned about my body and myself. 

By the time my ophthalmologist appointment came, they found the imaging of my fluid accumulation had already decreased. He was surprised and said the fluid was now only 1cc.

This is not to say that this is what YOU need to do. In fact, you shouldn’t. What you need is to root out the causes of inflammation and cortisol production for you. And now, I help people find out what those are.

Working with my patients now, I don’t take the “kitchen sink” approach I took. We take a less frantic, individualized approach that works. 

We audit your systems to root out where we can find cortisol-raising causes. It could be your hormones, emotional distress, insomnia, hypertension, blood sugar, digestive distress….

We all have the same goal – but there are different ways to get there. What we know is that we need to lower cortisol…as fast as we can. 

Since most cases self-resolve in 4 months, the first 4 months were crucial.  The faster we can resolve tissue damage the lower the risk of long-term damage. Anyone with chronic shoulder, wrist or ankle injuries know what I mean.

That is not to say people with longer-term CSR cannot be helped. I have treated those who have struggled with it for over one year…but still, time is of the essence.

A Whole Body Approach

Okay so where do we start?

First there are cortisol lowering herbs and nutrients that are really helpful. Plus there are lifestyle factors. But really we need to go deeper – go to the source.

Cortisol is increased in our bodies as a response to inflammation. In fact, it’s a protective mechanism against it.

The issue is when we produce too much cortisol for too long. Chronic, heightened cortisol starts to damage our tissues. It can cause weight gain, high blood sugar, skin problems….and eye damage of central serous chorioretinopathy.

But because it is protective against body inflammation, its triggered by so many things. Cardiovascular issues, hormonal imbalances, psychological stress…

To properly cut cortisol down at the legs, we need to find out what is pushing it. Sometimes it’s many things.

• I once spoke to a patient who had hormonal imbalances, liver disease and was struggling with the emotional distress of infertility. There was so much there.

• Another had high blood pressure, was pre-diabetic and battling chronic insomnia.

• Personally, I needed to cut anything causing unnecessary stress and strain in my life.

We want to be thorough and strategic, we need to audit your bodily systems line-by-line to root out potential sources of inflammation – and cortisol triggers.

Want to learn more about Naturopathic Options for CSR? 

Book a 15 min meet and greet.

Eye Health Itself

Along with decreasing cortisol production, we want to protect our eye tissue. 

We want to make sure that while damage is happening we support healthy eye cells to be as robust and resilient as possible.

Nutrients that help overall eye health: 

• Bilberry 
• Zinc
• Zeaxanthin 
• Lutein 

I prescribe many of these for my patients with other, non-CSR, tissue damaging eye disorders too.

Eye Rest:

We want to rest and relax the eye. Taxing it only puts more stress and pressure on it. Decrease screen time, give your eyes breaks throughout the day.  This is probably indirectly good for your stress levels and cortisol too.

Physical treatment:

I also perform acupuncture, helping to encourage drainage around the eye and also decreasing inflammation. This was important for me. Being pregnant I had so many limits on which herbs and medications are safe. So acupuncture was something I could do without worry and has no interactions with medications etc.

Year ago I worked in China at a hospital doing acupuncture on post-stroke recovery patients. I know just how amazing acupuncture can be for recovery. It can help with drainage, circulation along with regeneration of nerves and vessels.

When patients are far, I commiserate on how their local acupuncturist can help. If none are available, I teach them eye treatments and pressure points to aid this. We always find solutions.

Want to learn more about Naturopathic Options for CSR? 

And a whole body approach?

Book a 15 min meet and greet.

Final Thoughts

There is no argument that CSR disrupts your life. But I also think that this could be an opportunity to recalibrate how we live. Isn’t it a reminder that our stress, our other body imbalance have an impact? 

Can it serve as a wakeup call to stop ignoring our health, our stress levels and unhealthy patterns?

Once you decide to do laser, there is no turning back.I know those that have opted for the laser surgery who are now struggling with vision loss from that.

Not being able to see forces you to slow down and reflect. 

If we can come out of this experience healthier and more resilient, I consider that a win.

Want to learn more about Naturopathic Options for CSR? 

And a whole body approach?

Book a 15 min meet and greet.

Who Am I exactly? My name is Dr. Kristen Ma, ND and you can read about me HERE