Aim To evaluate clinical comorbidities and steroid use as risk factors for central serous retinopathy (CSR).

Methods Using national insurance databases, we conducted a case–control study of beneficiaries with an incident diagnosis of CSR between 2007 and 2015 (n=35 492) and randomly selected controls matched on age-based and sex-based propensity scores (n=1 77 460).

Results The mean age (SD) of cases was 49.1 (12.2) years, and the majority (69.2%) were male. Cases were more likely to have received steroids in the past year (OR 1.14, 95% CI 1.09 to 1.19, p<0.001) and to have comorbid Cushing’s syndrome (OR 2.19, 95% CI 1.33 to 3.59, p=0.002), age-related macular degeneration (OR 5.24, 95% CI 5.00 to 5.49, p<0.001), diabetic macular oedema (OR 2.05, 95% CI 1.71 to 2.47, p<0.001) and diabetes mellitus (OR 1.44, 95% CI 1.33 to 1.56, p<0.001). Glaucoma was associated with lower odds of CSR (OR 0.54, 95% CI 0.51 to 0.56, p<0.001). Patients with other previously hypothesised risk factors (including essential hypertension, pregnancy, other autoimmune disease, sleep disorders, Helicobacter pylori infection and gastro-oesophageal reflux disease) had lower odds of CSR.

Conclusions Male middle-aged patients with recent steroid exposure were significantly more likely to develop CSR. Other risk factors include diabetes mellitus, diabetic macular oedema and age-related macular degeneration. Other previously hypothesised risk factors did not appear to confer increased risk. More research is needed to confirm and examine underlying pathophysiology.