Discussion
Based on pathophysiologic pathway Minoxidil may be the culprit for CSC.
Capillary rearrangement and massive angiogenesis are the baseline events
for many retinal diseases. Scant data in literature defend the
hypothesis that Minoxidil enhances proliferation of choroidal vessels
and is related to CSC. The debate about the precise mechanism of this
association is still on the table. Direct toxic effect of Minoxidil on
retinal pigmented epithelium or vasodilation of choroidal vessels have
been mentioned[6]. In 2010, Dr. Reza Rastmanesh, described the
effect of Minoxidil on inducing Aquaporin 4 receptor which causes glial
cell swelling and edema. This pathway may also be involved in CSC
[7]. To date, there is not a confirmative consensus on the exact
mechanism, may be more than one mechanisms are involved.
The high prevalence of CSC and also Minoxidil usage is of note. May be
this is just a coincidence between two common things in young male
population. However, the unique feature of this case presentation is
unwanted increase in dosage of Minoxidil and deterioration of retinal
edema and patients symptoms in three weeks. This is in favor of the
causal role of Minoxidil in CSC pathophysiology.
Side effects of Minoxidil are unwanted facial/body hair, dizziness,
fainting, chest pain, unusual weight gain, etc. Conjunctivitis and
blurred vision were also mentioned[1], Possibly, into the future,
based on this article and previous studies by Dr. Sancrini and Dr.
Rastmanesh, CSC finds its way into adverse reaction column of
Minoxidil’s drug leaflet.
Recently a case report has also postulated the relation between long
term Minoxidil usage and CSC in a 41 years old man. Eplerenon was
suggested as an effective therapy in this situation. Compared to their
report, in our case presentation the duration of Minoxidil usage was
shorter and CSC did not improve by Eplerenon. We think Eplerenon is no
more than placebo in CSC treatment and discontinuation of Minoxidil is
the first option[8].
Finally, may be an important message of this article to the medical
researchers and staffs is: whenever you face a patient with CSC it worth
taking full drug history specifically steroid and Minoxidil.
Funding: None
Informed consent was taken from patient.
CONFLICT OF INTEREST: The authors have no conflict of interest
to declare.
Ethical Approval Code: IR-TUMS.VCR.REC.1399.456