Supplementary surprise – L arginine induced central serous retinopathy?

Central serous retinopathy (CSR) is a retinal disorder causing serous macular detachment, often linked to stress and corticosteroid use. Drug-induced CSR is rare. We present a case of a 30-year-old male with chronic, recurrent CSR over 2 years, retrospectively linked to L-arginine supplementation for muscle growth, as suggested by a gym trianer. The patient experienced multiple episodes of blurred vision, which did not resolve completely with medication, with optical coherence tomography confirming subretinal fluid. Despite standard treatment, recurrences continued until L-arginine use was identified. Discontinuation led to fluid resolution and visual stabilization. The exact mechanism may involve L-arginine-induced nitric oxide production, causing choroidal vasodilation and hyperpermeability. This case highlights the importance of a thorough drug history in recurrent CSR and raises awareness of L-arginine as a potential trigger. Early identification and withdrawal of the causative agent are crucial for managing chronic CSR.