Unraveling the Puzzle of Central Serous Chorioretinopathy: Exploring Psychological Factors and Pathophysiological Mechanisms

Central serous chorioretinopathy (CSCR) is a relatively common retinal disease involving the localized serous detachment of the neurosensory retina from the retinal pigment epithelium (RPE). Research suggests that individuals with a Type A personality, exhibiting traits such as competitiveness, urgency, aggression, and hostility, are significantly more prone to developing CSCR. Several studies have confirmed that a propensity to stress as well as different stressful events may predispose subjects to the development and recurrence of CSCR. Patients with CSCR are more depressive, report a higher level of anxiety and use more psychopharmacologic medications. Despite the research conducted on the topic, it remains unclear how a variety of psychological factors can contribute to dysfunction and pathological changes in the choroid and RPE. Some authors propose that increased levels of sympathetic neurotransmitters and glucocorticoids may alter the choroidal blood flow and increase the permeability of choriocapillaris in CSCR patients. It is generally accepted that hyperpermeable choroidal vessels are responsible for increased tissue hydrostatic pressure, which promotes RPE detachment, breaks the barrier function of the RPE and leads to subretinal fluid accumulation. Although the etiological factors and pathophysiological mechanisms have still not been fully clarified, CSCR is most likely a multifactorial disease involving disturbed interrelationships between biological and psychological factors. This comprehensive review aims to provide an up-to-date exploration of the psychological factors and pathophysiological mechanisms associated with CSCR.