Supplementary Material for: Levonorgestrel as a Potential Trigger of Acute Bilateral Central Serous Chorioretinopathy: Case Report

This is a first ever report describing a case of acute bilateral central serous chorioretinopathy which developed shortly after the consumption of levonorgestrel as emergency contraception. A 27-year-old female patient visited the emergency department of the clinic due to diminished visual acuity in both eyes. She had taken a single pill of levonorgestrel (1.5 mg) as emergency contraception 2 days prior. Fundus examination showed macular edema. Optical coherence tomography (OCT) revealed serous bilateral detachment of the macular retina. Fluorescein angiography showed a “smokestack” leakage of contrast in the right eye and focal macular leakage in the left eye. Ten days after oral diuretic and topical nonsteroidal anti-inflammatory drugs were prescribed, follow-up examination revealed improvement of best corrected visual acuity and OCT showed complete regression of subretinal fluid. One month and 3 months after the initial visit, the patient’s best corrected visual acuity returned to 20/20 and OCT showed no signs of subretinal fluid. This case highlights levonorgestrel as a potential trigger for this serious chorioretinal condition, thus expanding on the literature on possible risk factors and mechanisms of development for central serous chorioretinopathy.