Abstract： Objective To observe the optical imaging features of the acute central serous chorioretinopathy (CSC) with grayish lesion.Methods The data of 23 patients (26 eyes) diagnosed as acute CSC by direct/indirect ophthalmoscope,color fundus photograph,fluorescence fundus angiography (FFA),indocyanine green angiography (ICGA) and fourier-domain optical coherence tomography (FD-OCT) were retrospectively analyzed.The appearances of the grayish lesions in the color fundus photograph,FFA,ICGA and FD-OCT were mainly observed by contrast to analyze their relations.Results One to three retinal pigment epithelium (RPE) active leakage sites presented at the site of the grayish lesion of 26 eyes (100.00％) in the early and the lesions showed strong staining in the later during the FFA.The location of the grayish lesion showed plaque hypofluorescence in which the chorioidal artery delayed filling and there also had ICG dye leakage which were accord with the RPE active leakage sites in the FFA in 26 eyes (100.00％) in the early during the ICGA.Within the lesions,there were strip hyperfluorescence focus appearing in 23 eyes (88.46％) and plaque hyperfluorescence focus in 5 eyes (15.39％) because of the choroidal vein dilated and the choriocapillary dilated in the site of the grayish lesion respectively.The grayish lesion also showed hyperfluorescence due to the tissue stained in the later during the ICGA.In the FD-OCT,there were moderate or high reflective masses bridging the neurosensory retina and the pigment epithelial detachment (PED) which showed pillar or circle shape in the site of grayish lesion in 26 eyes (100.00％),and the RPE of PED were broken partly in 5 eyes (15.39％).Conclusions The acute CSC with grayish lesion has its own optical imaging characteristics.There are RPE active leakage sites appearing in the location of the grayish lesions in the early and the tissue strong staining in the late during the FFA.The choroidal vessels perfuse poorly or high in the early and the tissue also strong staining in the late during the ICGA.There are moderate or high reflective masses bridging the neurosensory retina and the PED beneath the detached neurosensory retina at the area of grayish lesion,the PED may be associated with RPE broken partialy in the FD-OCT.