Corneal Nerve Abnormalities Detected in CSCR Patients

A recent study aimed to investigate the presence of corneal nerve abnormalities in patients with chronic central serous chorioretinopathy (CSCR). The cornea and choroid share a common neural pathway through the long ciliary nerves, and systemic dysautonomia—as seen in CSCR—can influence nerve function and morphology in these interconnected structures. The study authors hypothesized that corneal nerve changes may reflect underlying choroidal nerve health. Fourteen out of 15 patients with chronic CSCR in this study exhibited significant corneal nerve fiber abnormalities, such as hypertrophic subepithelial nerve plexi, twisted nerve fibers and marked nerve rarefaction, reinforcing the researchers’ hypothesis that corneal nerve alterations could reflect underlying choroidal neuropathy. These images from the study show (A) schematic representation of the intraocular innervation and (B) large ciliary nerves coming from the choroid, entering the limbus and then forming corneal innervation, highlighting the link between the choroidal and the corneal innervation. Photo: Bourges JL, et al. Ophthalmol Sci. August 29. 2025. Click image to enlarge. The study, conducted in Paris, employed a case-control design to investigate corneal nerve fiber (CNF) abnormalities in patients with chronic central serous chorioretinopathy (CSCR) using in vivo confocal microscopy. A total of 15 chronic CSCR patients and 11 age-matched controls without corneal disease were analyzed. The methodology included systematic imaging of the cornea across five distinct layers: the subepithelial area, Bowman’s layer and the anterior, intermediate and deep stroma. The CNF abnormalities were scored by two independent graders who classified them based on prevalence and severity across different layers. The results indicated that nearly all CSCR patients exhibited significant CNF abnormalities, including features such as hypertrophic subepithelial nerve plexi, twisted nerve fibers and marked nerve rarefaction, which starkly contrasted with the control group where most subjects displayed normal CNF morphology. Statistically significant differences were noted across all examined layers, reinforcing the hypothesis that corneal nerve alterations could reflect underlying choroidal neuropathy.“Due to its transparency and easy access, the cornea is an ideal tissue for noninvasive analysis of peripheral sensory nerves, which may be altered in ocular and systemic diseases, even in the absence of ocular-associated symptoms,” the researchers wrote in their paper for Ophthalmology Science. Given that the corneal abnormalities observed in chronic CSCR patients “were not associated with any clinically detectable corneal pathology or symptoms,” the authors explained, the mechanism “may be related to a broader alteration of peripheral nerves, as CSCR patients exhibit functional signs of dysautonomia, measured by heart rate variability and pupillometric responses.” The study's limitations include its qualitative design, lack of a validated automatic method for quantifying corneal nerve abnormalities and lower image analysis in CSCR patients. Additionally, it did not assess functional parameters of the ocular surface, and the small sample size limits applicability to all chronic CSCR patients.The researchers concluded that while larger cohorts are needed to confirm their findings, “Corneal nerve changes may serve as a noninvasive marker” in patients with chronic CSCR, “warranting investigation into shared neuropathic mechanisms.”Click here for the journal source. Bourges JL, Leclercq B, Behar-Cohen F. Corneal nerves abnormalities in chronic central serous chorioretinopathy. Ophthalmol Sci. August 29. 2025. [Epub ahead of print].This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.