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Year : 2022  |  Volume : 12  |  Issue : 4  |  Page : 381-393

Central serous chorioretinopathy: Pathophysiology, systemic associations, and a novel etiological classification

1 Department of Ophthalmology, Al Dhannah Hospital, Abu Dhabi, United Arab Emirates
2 Department of Vitreous and Retina, Rajan Eye Care Hospital, Chennai, Tamil Nadu, India
3 Department of Ophthalmology, Leiden University Medical Centre, Leiden, The Netherlands

Correspondence Address:
Dr. Manish Jain
Department of Ophthalmology, Al Dhannah Hospital, Abu Dhabi
United Arab Emirates
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2211-5056.362601

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Central serous chorioretinopathy (CSC) has remained an enigmatic disease since its initial description by Von Graefe. Over the years, multiple risk factors have been recognized: these include psychological stress, behavioral traits, and corticosteroids. The basic pathophysiology of CSC involves choroidal thickening, vascular congestion, altered choroidal blood flow (ChBF), and choroidal hyperpermeability, leading to retinal pigment epithelium decompensation and subsequent neurosensory detachment. Multiple organ systems, mainly the nervous, cardiovascular, endocrinal, and renal systems participate in the control of the vascular tone and the ChBF via hypothalamus–pituitary–adrenal axis and renin–angiotensin–aldosterone system, while others such as the hepatic system regulate the enzymatic degradation of corticosteroids. Many vasoactive and psychotropic drugs also modulate the ocular perfusion. In addition, there are anatomical and genetic predispositions that determine its progression to the chronic or recurrent form, through cellular response and angiogenesis. We herein review the basic pathophysiology and immunogenetics in CSC along with the role of multiple organ systems. With this background, we propose an etiological classification that should provide a framework for customized therapeutic interventions.

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