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.