Minoxidil and bilateral central serous chorioretinopathy in an adolescent girl: relationship or causality?

Abstract

Objective: This report describes a case of bilateral central serous chorioretinopathy linked to cosmetic minoxidil use in an adolescent girl, highlighting clinical findings, progression, and implications for practice.Materials and methods: Case report.

Results: A 14-year-old girl with no significant medical history reported several weeks of blurred vision in both eyes. She had been using 2% topical minoxidil on her eyebrows and eyelashes without a prescription for the past 6 months. The initial examination revealed that the best-corrected visual acuity (BCVA) was 20/80 in the right eye and 20/25 in the left eye, with no abnormalities noted in the anterior segment. Fundus evaluation and OCT confirmed bilateral serous retinal detachment. Given the patient's unsupervised minoxidil use, a causal link to central serous chorioretinopathy (CSC) was suspected. After discontinuing the drug, the subretinal fluid (SRF) resolved, and visual acuity fully recovered within three months, supporting the association between minoxidil and choroidal neovascularization (CNV), not CSC.

Discussion: Topical minoxidil has been widely used due to its vasodilatory, anti-inflammatory, anti-androgenic, and trichogenic properties, primarily through its induction of the Wnt/β-catenin signaling pathway. Despite its benefits, adverse effects such as hypotension, pruritus, and hypertrichosis are common, and isolated reports have linked its use to CSC, with symptoms typically resolving after discontinuation of the drug in most case studies. Proposed mechanisms for this association include systemic absorption leading to increased choroidal vascular permeability and disruption of retinal homeostasis. To our knowledge, this is the first reported case in the literature of bilateral CSC linked to cosmetic minoxidil use in an adolescent girl, with complete resorption of SRF and recovery of visual acuity following discontinuation of the drug.

Conclusion: CSC linked to topical minoxidil use is rare and requires early detection for prompt discontinuation and recovery. Further research is needed to confirm this link, understand the underlying mechanisms, and develop more effective treatments.