Case Presentation
A 39 years old healthy cardiologist (A. Bozorgi) presented with metamorphopsia and central scotoma dominantly in the right eye. He was examined by his ophthalmologist. After dilated eye examination he ordered for retinal imaging. Dr. Bozorgi underwent optical coherence tomography (OCT) the day after, Figure 1. Along with OCT his ophthalmologist performed Fluorescein angiography to decide the appropriate therapy and plausibility of photodynamic therapy PDT. OCT and angiography were both in favor of CSC. He was asked about his past medical history and also history of steroid usage; which all were negative but 2% topical Minoxidil since 2 months ago. He was reassured that this disease is not only common but also is self-limiting and the definite etiology is unknown yet. Eplerenone was started and wait and watch approach was suggested. However, as an electrophysiologist he needed his eye to be the same as before ASAP. Unfortunately after almost 3 weeks his symptoms progressed and his job was affected. He sought for second medical opinion from another well-known ophthalmologist; and the same tests were ordered again. The leakage and the Sub-retinal fluid were increased, Figure 2, and he started to panic! Nothing was changed in his life style in these 3 weeks to justify the progression of CSC but the dosage of topical Minoxidil which was increased from 2% to 5%. So far, everything was toward the stressful job and a type A personality as the culprit for this progression. He was not convinced and as a researcher he started to search the net himself to find the answer!
In 2011 Dr. Scarinci and his colleagues in Italy, reported a case with CSC in which the patient was on Minoxidil and discussed about the relation between these two. After almost 3 months, on the impression of that article, he stopped Minoxidil and the symptoms were subsided in about 10 days. Follow up OCT was also in favor of improving retinal damage after Minoxidil discontinuation, Figure 3.