Beyond the vision: central serous chorioretinopathy, anxiety and depression–a systematic review

Background: Central Serous Chorioretinopathy (CSCR) is an exudative maculopathy characterized by serous retinal detachment, choroidal hyperpermeability, and retinal pigment epithelium dysfunction. Beyond its ocular features, CSCR has long been associated with stress-related mechanisms and emotional dysregulation. Psychological factors such as anxiety and depression may influence disease onset, recurrence, and recovery; however, no previous review has systematically synthesized quantitative evidence on these variables in CSCR. Methods: This systematic review followed the PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251160719). PubMed, Scopus, and Web of Science were searched in October 2025 using the terms “Central Serous Retinopathy” AND Anxiety AND Depression. Eligible studies included peerreviewed, English-language articles employing standardized psychometric instruments to assess anxiety and/or depression in CSCR patients. Twenty studies met the inclusion criteria, comprising 19 case control and one longitudinal cohort design. Results: Across the included studies, depressive symptoms were significantly higher in CSCR patients in most investigations, indicating a consistent affective vulnerability. Findings for state anxiety were more heterogeneous, with approximately half of the studies reporting significant group differences. Evidence on trait anxiety was limited but suggested potential links with physiological dysregulation, including altered neurovascular coupling. Overall, psychological distress-particularly depressive symptoms-emerged as a frequent and clinically meaningful correlate of CSCR. Conclusion: The present review provides the first comprehensive synthesis of quantitative evidence linking anxiety and depression with CSCR. These findings highlight the need for routine psychological screening and integrative management in ophthalmology. Future longitudinal and interventional research is warranted to clarify causal pathways and evaluate targeted psychological or stress-reduction interventions, ultimately promoting holistic care that addresses both the visual and emotional dimensions of this condition.