Central Serous Retinopathy (CSR), also known as Central Serous Chorioretinopathy (CSCR), is a condition where fluid accumulates under the retina, causing central vision to become blurry or distorted. While factors like stress and Type A personality traits have been linked to CSR, a significant number of cases are attributed to exogenous (outside the body) and endogenous (inside the body) corticosteroids. Beyond steroids, a growing list of medications, from cancer treatments to common over-the-counter drugs, have been implicated in triggering or exacerbating this retinal disorder. The key to management often involves identifying and, under medical supervision, discontinuing the offending medication.
The Strongest Link: Corticosteroids
Corticosteroids, a class of anti-inflammatory drugs, have the most robust association with CSR. Their use is strongly correlated with an increased risk of developing the condition, regardless of the route of administration.
Systemic Corticosteroids
These are typically taken orally or via injection for conditions such as autoimmune disorders, asthma, and inflammatory diseases. Studies have found a dramatically increased odds ratio for CSR in patients using systemic steroids. High doses and prolonged use are particularly risky, but even low-dose oral steroids can trigger CSR.
Inhaled and Topical Corticosteroids
It is a common misconception that localized steroid use is safe for the eyes. Case reports demonstrate that inhaled corticosteroids for asthma and nasal sprays for allergies can cause CSR. Similarly, high-potency topical steroid creams used on the skin have been linked to the condition. This underscores the importance of a comprehensive medical history when evaluating a patient with CSR, as all forms of steroid exposure should be considered.
Other Medications Linked to Central Serous Retinopathy
While corticosteroids are the primary culprits, research has identified a diverse range of other drugs that can contribute to or trigger CSR.
Cancer Medications
- MEK Inhibitors: Used to treat certain types of melanoma and other cancers, MEK inhibitors like cobimetinib and trametinib can cause serous retinal detachments.
- BRAF Inhibitors: Often used in combination with MEK inhibitors, these drugs can also trigger CSR.
- Checkpoint Inhibitors: Some immunotherapies can induce a variety of ocular side effects, including serous retinal detachments.
- Tamoxifen: This breast cancer drug has toxic effects on the retinal pigment epithelium and can lead to fluid accumulation.
Psychiatric and Neurological Drugs
- Quetiapine: This atypical antipsychotic has been associated with CSR, potentially by affecting choroidal blood flow through dopamine and serotonin pathways.
- Pregabalin: Case reports suggest this medication, used for neuropathic pain and anxiety, may trigger CSR.
Cardiovascular and Stimulant Drugs
- Sympathomimetics: Drugs that increase sympathetic nervous system activity, such as Adderall (dextroamphetamine-amphetamine), pseudoephedrine (a decongestant), and illicit substances like MDMA (ecstasy), have been linked to CSR.
- Phosphodiesterase-5 (PDE-5) Inhibitors: Medications for erectile dysfunction, like sildenafil (Viagra), have been associated with CSR.
- Aspirin: High doses of aspirin, particularly in the context of hypercoagulability, have been explored as a potential contributor.
Other Drug Classes
- Antibiotics: Some antibiotics, including rifampin, have been linked to CSR.
- Sulfa-derived drugs: These medications can cause choroidal effusion and retinal folds, mimicking or potentially causing CSR.
- Interferon: Used for conditions like multiple sclerosis and hepatitis, interferon can induce ocular toxicity, including CSR.
- Finasteride: Some reports have linked this drug for prostate enlargement and hair loss to CSR.
Comparison of Key Drug Categories and CSR Risk
| Drug Category | Examples | Routes of Administration | Mechanism of Action | Risk Level |
|---|---|---|---|---|
| Corticosteroids | Prednisone, Dexamethasone, Flonase, Hydrocortisone cream | Oral, IV, Inhaled, Topical, Nasal | Upregulation of mineralocorticoid receptors; altered choroidal blood flow | High and Confirmed |
| Sympathomimetics | Adderall, Pseudoephedrine, MDMA | Oral, Nasal, Illicit | Increased sympathetic activity and vascular changes | Probable/Case Reports |
| MEK/BRAF Inhibitors | Cobimetinib, Trametinib | Oral | Disrupts intracellular signaling pathways, causing retinal detachment | High for Chronic Users |
| PDE-5 Inhibitors | Sildenafil (Viagra) | Oral | Altered blood flow and vascular permeability in the choroid | Probable/Case Reports |
| Atypical Antipsychotics | Quetiapine | Oral | Modulates dopamine/serotonin, affecting choroidal circulation | Probable/Case Reports |
Pathophysiology and Diagnosis
Though not fully understood, the underlying mechanism of drug-induced CSR involves an abnormal increase in the permeability of the choroidal capillaries, the blood vessel layer beneath the retina. This leads to fluid leakage, which collects under the retina and separates it from the underlying tissue. Retinal pigment epithelium (RPE) cells are also affected, contributing to the fluid buildup.
Diagnosis is confirmed through a comprehensive eye exam by an ophthalmologist, which includes retinal imaging techniques. Optical Coherence Tomography (OCT) is crucial for visualizing the subretinal fluid. Fluorescein Angiography (FA), a test using a fluorescent dye, can detect the specific leakage sites. The doctor will also take a detailed history of all medications to identify potential culprits.
Conclusion
The association between certain medications and the development of central serous retinopathy is well-documented, with corticosteroids being the most prominent cause. However, it is important for both physicians and patients to be aware that other drug classes, including cancer therapies, stimulants, and psychiatric medications, can also trigger this condition. The potential for vision-related side effects from seemingly unrelated drug therapies highlights the need for a thorough medical and medication history in patients presenting with CSR symptoms. Early detection and, where appropriate, discontinuing the offending medication under a doctor's care are often key steps toward successful visual recovery.
For more detailed information, consult the resource on Drug Induced Maculopathy from the American Society of Retina Specialists.
What to Do If You Suspect Drug-Induced CSR
If you experience blurred or distorted vision, especially if you are taking any of the medications listed above, it is essential to contact an ophthalmologist promptly. A retinal specialist can properly diagnose the condition and determine if a medication is the likely cause. Do not stop any prescribed medication without first consulting your prescribing physician, as abrupt discontinuation can be medically unsafe.
