Central Serous Retinopathy: the new carpal tunnel for information workers

Is Central Serous Retinopathy (CSR) the new carpal tunnel for a generation of over-stressed and over-loaded information workers who spend far too many hours per day staring at screens of varying dimensions?

Central serous retinopathy (or choroidopathy) is essentially a delamination of the retina when cellular layers that normally serve as a fluid barrier between the choroid and the retina begin to leak. This introduces a bubble or blister of fluid underneath the retina. This results in blurred and dimmed vision.

Although CSR is idiopathic, it has been linked to chronic stress, defined biochemically as elevated serum cortisol levels. This finding is corroborated by an increased incidence of CSR in those with Cushing’s Syndrome (chronic overexposure to elevated levels of cortisol.) Men are more often affected than women; with an age of onset between 20-50, averaging around 45.

I’ve been having progressively worse vision problems since December that I had attributed to floaters or sleep deprivation. Given the sad state of my own personal health care coverage as a self-employeed worker and the prevalence of holidays and work deadlines around the turnover of a new year, I didn’t get around to checking this out until this week. After a standard eye exam, I was tentatively diagnosed with Central Serous Retinopathy (CSR), confirmed a few days later by fluoroscein angiography.

My symptoms currently include a large purplish gray blotch almost dead-center in my field of vision; completely distorted visual acuity that’s not just blurry but makes straight lines look broken and covered with Adobe’s marching ants from using the lasso tool; micropsia (things appear smaller than the unaffected eye); loss of several aspects of color perception; and — surprise — everything looks dim and desaturated.

I’m certainly not a high stress individual. I’m not Type-A; I don’t go around yelling at people. I am, however, a perfectionist, although I’ve softened in my old age. Now I’m satisfied if things are done as best as they possibly can be with the time and team available.

I do work hard and I work long hours and have been doing so for many years.

Here’s a brief outline of a typical day for me.

Wake up early, anytime between 3-4:30 am. Roll over and check the time on my phone. Check my email. Read about things I need to deal with and decide to just get up. Espresso. Since I’m a teleworker, lunch was almost always a working lunch at my desk. And without any seminars or Bits ‘n’ Nibbles to attend in the afternoon, I’d work straight through until 6, 7 or 8, with a full work day of 15, 16, or 17 hours. Multiply that times seven and I was typically logging close to 100 hours a week, each week, weekends and holidays inclusive.

So what am I doing to change? First off, I’m no longer tethered to my phone. If I’m not working, I’m not answering work emails. I’m waiting until I’m actually at my desk to start working. And I’m making every effort to reclaim my weekends and holidays and not working at all. And I’m keeping my fingers crossed I retain my vision.

Comments

  1. Penn Young says

    Hello,

    I was just Dx w CSR last Wednesday and I have been obsessively reading and researching about the disease and prognosis online. I am currently under the care of a retina specialist and my treatment is to simply wait for self-resolution. I was advised to decrease my stress levels as well.

    I was wondering how you were doing and if you had experienced (in addition to your mentioned symptoms) night vision deficit ( or almost night vision loss) , and how you were today. I hope you are well.

    Thank you.

    Penn

  2. Rachel says

    …6 months later – how is your CSR? I’m in the same boat, so just curious about your progress. Mine has been hanging on for some more than the “3-6 months”. More like 1.5 years. Finally just in the past couple days, my ‘red ring’ when lights hit it just right, is all but gone. I’m trying to not get excited and jinx it (or scare it away. Ha.)
    I’ve read that treatment should be sought if it lasts longer than 6 months. Not one to enjoy confirmed bad news, I haven’t talked to my eye doc since diagnosed…but maybe with the disappearance of the grey blob, I’ll give a call and hear some good news…
    Happy weekend!

  3. jean says

    My son was diagnosed with CSR about 3 years ago. He is almost blind in one eye because of scaring from the bleeding and the other eye is also effected. I am looking now to see if anything is new in its care.

  4. says

    i had this problem, undiagnosed properly though, years ago in 1995. no meds were working to improve my vision. buck then I was a student, taking a social work course with extensive focus on stress – what high levels of cortisol could do to the organs. to my surprise long hours of fixed position of your body fells into category of putting your body on high stress, and it doesn’t matter if the environment when it happens is peaceful. fixed position of eyes or not much diversify movement is probably the cause. introducing frequent activities that forced my eyes to change focus to long-short-long-short and turn eyeballs into different directions like swimming and skiing helped. at least this is what i think it helped me to heal, after four months.
    there is no harm to try it, hope it helps somebody. sending best vibes!

    • Todd Harris says

      Marzzzena – Thanks for your suggestion! It makes sense to me.

      CSR is such a “black box”. It’s always good to hear what has worked for people and sadly, what hasn’t.

    • Todd Harris says

      I’ve had three or four more episodes since the first occurrence. I’m getting used to it. The onset is rapid. I usually notice when I’m staring at a blank wall, not that I sit around staring at blank walls often.

      Resolution is slow and on the order of months for me.

      Because my vision insurance sucks (which is to say that I don’t have any), I haven’t had any diagnostics since the first incident and I’ve never been treated. From my reading, available treatments MAY but do not necessarily increase the rate of resolution but do not affect the rate of recurrence. That simply isn’t a good value proposition to me.

      I do have permanent damage from — I think — the first incident. It’s a pinpoint blurred dot just off the middle of my vision. I can live with that. But if my vision was peppered with them, I would be truly bummed.

  5. Anonymous says

    Central Serous Retinopathy (CSR)

    CSR is mostly a stress condition. One stressful event or overall stress will cause it, Also high cortisone levels. The more you focus on it, the worse it will get. It may be associated with high cortisone and possibly Cushing syndrome, insomnia, stress and hypertension.

    My conclusion after 20 years of experience with CSR:

    My Action plan:
    1. Avoid Stress. Try stress reduction-meditation, etc.. Get enough sleep.
    2. Avoid excess salt (sodium), Crackers, sodas, pizza, etc. (salt has stimulating qualities and can worsen insomnia, hypertension, edema, etc.). It seems to make my CSR worse.
    3. Avoid all stimulants, caffeine, tobacco, herbal stimulants, albuterol, Etc
    4. Some Studies have shown taking vitamins and supplements may make CSR worse or have no effect. Avoid most of them. Just one study: http://www.omicsonline.org/exacerbating-factor-of-central-serous-chorioretinopathy-2155-9570.1000259.pdf. Most herbs and vitamins seem to make my eves worse.
    5. Avoid all forms of Cortisone.
    6. Exercise, walk, swim, get a hobby that does not require eye strain or videos.
    7. Avoid excess computer, cell phone, TV, Video usage.
    8. Do Bates eye exercises (Bates Method). See YouTube for instructions. Do sunning with eyes closed, palming and swings.
    9. Work Reflexology eye points around the toes, see chart below.
    10. Monitor your blood pressures and stress level.
    11. Work Eye acupressure points, see chart below and Google.
    12. Eat spinach and some form of blueberries 3 times a week to avoid macular degeneration.
    13. Find yourself a good Retina specialist.

    Work Reflexology eye and ear points or any sore points around the toes:

    Bates method, see YouTube for a demonstration:
    1. Long Swings 5 to 10 minutes 2 to 3x per day.
    2. Palming 5 to 10 minutes 2 to 3x per day.
    3. Sunning with eyes shut only.

    Most vitamin and supplements seem to make my eye worse, Q10, etc. Potassium (Potassium chloride) in small doses (99MG) or less is the only one that seemed to help me reduce the distortion/fluid buildup. It costs about $5 for a bottle of 100 tablets. Always take potassium with food to avoid an upset stomach. Warning Potassium chloride is extremely toxic in large doses. Check with your doctor before using. Other forms of potassium may or may not work. The Potassium seems to reduce my distortion and fluid buildup however it may or may not result in a seal of the leak or a complete resolution.

    Google “eye acupressure” for more details. Work acupressure points around eyes:

    The above instructions have shortened my CSR duration by weeks or months.

    The more you focus on CSR, the worse it will get and the longer it will take to resolve.

    Disclaimer:
    I am not a doctor. I do not treat, diagnose or prescribe. If you have any illness, please refer to a medical doctor for advice. The above text is for information use only. I have no conflict of interest.

    4/18/2016

    • Raeph says

      @Anon Interesting comments about supplements and CSR. My CSR flared up today and I recently started taking Magnesium Chloride and B12 supplements. The Magnesium has been great for my skin and sleep and I ‘feel’ good, but my eye seems unhappy again.

  6. NADINE PRITCHARD says

    Hi. I have recurrent CSR bilaterally for 4 years now. It started to affect my right cental vision and I now have damage to my macula. Permanent distortion. It was not affecting the left central until recently and I am petrified. I have been seeing a great retina specialist. One who thinks outside the box , as any of you know there are not many treatments for this disease. I believe it was a result of a course of epidural steroid injections I received for back pain. In any case because I also have Nyclatopia dyschromatopia, metamorphisia , contrast sensitivity and choroidal neovascularization, my Dr and I decided to start treating with Eyelea with some success. At least we think. My right went from 20/200 to 20/25. I still have the issues mentioned and recurring fluid but it seems to be a sort of bandaid to help curtail the fluid and frequency. I have been looking for people to talk to about this disease. I am so afraid I will lose my sight. It could be 10 years. Could be 2. Who knows. My dr has never treated a case like mine and being the nerd, haha, that he is , finds it fascinating and is working to research more options for me. Thank goodness. I just wanted to share some of my experience. Feel free , anyone to reach out if you have questions about it. Thanks for listening. Nadine P., Raleigh NC.

    • Carrie says

      Hi there. I have had CSR in both eyes for about 5 yrs now. I ended up having laser surgery on the right as the leak would not resolve in over a year. I’ve had 3 recurrent episodes that have resolved on their own. I do have some permanent loss in the right eye….blurry, objects are darker and farther. I am wondering if staring at a computer screen all day would have any negative affect?

      Carrie

      • Todd Harris says

        Hi Carrie – Anecdotally and in my experience, staring at the same focal length all day long is an aggravating factor for recurrent episodes of CSR. I’d suggest scheduling regular breaks, trying to look up and around periodically. While I don’t believe that eye strain in and of itself causes CSR, it probably doesn’t help. Wishing you the best of luck.

  7. NADINE PRITCHARD says

    Todd I also have some ideas if assistive technology for the visually impaired if your interested in hearing about it.

  8. deale says

    i am an older female with csr after removal of 95% of a psuedotumour in the left eye. if i could give advice to anyone with a similar circumstance i would say avoid surgery if you can. it only comes on in the left eye even though both eyes are dry. i was also left scarred and the eyelid droops. the csr seems to be triggered by hormonal changes. the last one was 2 months ago after i stopped breastfeeding and went back on estrogen and progesterone hrt but also i started drinking caffeinated coffee. i had dropped my eye supplement during pg and so started back with it along with more rigourous exercise and now the condition seems to be getting better. i also started restasis however i have been waking up occasionally with my left eye rolled back into my head and cannot focus immediately or roll it forward immediately. scary! so stopped restasis and will see if it clears up. this is awful!

  9. raymond harjo says

    It sucks. Im terrified but determined to find the natural solution… first episode went away un weeks with intermittemt fastung amd grear diet. Got off and went back to bad food and such and now its back… round two i will let you guys know.

  10. Brandon says

    So just want to put my story out there so others can reference it as it may help them.

    I developed this disorder on 5.10.2018. In a panic I immediately went to see my eye doctor. They were quickly able to diagnose me with CSC/CSR. Told me it was stress related and to come back every month for the next 3-6 months until it was healed.

    A little about myself and stress levels.
    At the time, I did not feel I was under any considerable amount of stress at work or at home (married with 3 kids).
    I was however in the middle of a weight loss journey. I had recently lost 45lbs (205lbs to 160lbs) from November 2017-April 2018. I was diagnosed with hypertension and was put on lisinipril. I made it my lifes goal to drop my weight, eat healthy and get my blood pressure under control. In april my hypertension had resolved and my doctor removed me from the medication. I do not think or believe the medication (or lack thereof after stopping) or weight loss had anything to do with

    I had reached a plateau and couldn’t lose anymore weight. In an effort to lose another 10 lbs, I decided to double down on what had been working in the past. I was waking up at 3:30am and going to the gym to get some HIIT cardio and weight lifting in, 5 days a week. I also started supplementing with creatine, citruline malate.and yohimbine.

    I have done a lot of research and I do believe that the combination of the above is what caused the CSC/CSR. Doing research into weightloss, which prompted my purchase of yohimbine is that it helps with a catecholamines response that helps with the rapid breakdown of fat. It was my goal to do HIIT cardio while taking yohimbine. Prior to my research into catecholamines, I had never heard of the work, or any knowledge of what it was or did. I have come across countless articles about CSC since I was diagnosed and for there is that damn word, catecholamines, in article after article. Mere coincidence? Maybe, but I feel I have to atleast mention it here as I would like anyone else with a common story or situation to comment on it, call it confirmation bias if you will.

    Ill just drop this link about yohimbine.
    https://www.ncbi.nlm.nih.gov/pubmed/7662240

    Link about catecholamines and CSC
    https://www.ncbi.nlm.nih.gov/pubmed/14526445

    Anyway, knowledge in hand I implemented the following protocol to see if I could get this to go away. My research into CSC/CSR has led me to articles stating low dose aspirin significantly reduced the time for healing.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921298/

    1. Low dose aspirin daily
    2. Discontinuation of HIIT cardio
    3. Discontinuation of yohimbine.
    4. Cut down on 5x a week gym
    5. Get more sleep.

    within a week, the big purple/grey dot affecting my central vision started to get smaller in size.
    within a month it was almost completely gone. confirmed by eye doctor on June 11th. I saw the image of the before and after that their medical equipment takes and it was pretty much gone. My visual confirmation showed it.

    Given the all clear, I resumed HIIT cardio and within 2 days (June 14th), its back, same spot, not quite as bad as before, but very prominent. I am currently self monitoring it to see if it gets bigger and more noticable. In my case, I am certain that there is a catecholamine (no-epeniphrine/epinephrine) fight or flight response from HIIT that is triggering my CSR/CSC. I have not resumed the yohimbine, so if this was catecholamine related, it was because of the HIIT. I have also done more research that indicates that caffiene may be a trigger. I had been taking 300mg pre-workout, but I was taking this prior and during my last bout of CSC/CSR and it didnt affect the resolution. But I have to consider that maybe it was a contributing factor and potentially slowed my healing during the first bout.

    This go around, I am going to see I can do the following.
    1. Low dose aspirin daily
    2. Discontinuation of HIIT cardio
    3. Cut down on 5x a week gym
    4. Get more sleep.
    5. Stop drinking caffiene.

    I also read a guy that swore by naproxin (aleve). I may give that a try for research sake.

    Well that is my story, I hope it helps someone. I hope that my story can help, even if its just a piece of the puzzle.

    • Todd Harris says

      Thanks for your post, Brandon. Lots of good information there.

      I’ve heard many reports associating CSR with weight training, and I would imagine with HIIT, too. I notice that I’ll have episodes when I’m in the gym a lot.

      At the end of the day, it seems like so little is known about effective treatments. Sufficient sleep and reducing stress seem to be the most common and effective things. Good luck and keep us posted!

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