Uveal Effusion and Exudative Macular Detachment Secondary to SSRI and Dexamphetamine Overdose

To report a case of unilateral choroidal effusion and exudative macular detachment following intentional overdose involving paroxetine and dexamphetamine in an adolescent patient.

A 14-year-old female with obsessive-compulsive disorder (OCD) and attention deficit/hyperactivity disorder (ADHD), taking paroxetine, dexamphetamine, guanfacine, and hydroxyzine, was admitted with serotonin syndrome and anticholinergic toxicity following ingestion of multiple medications. Two days later, she developed acute unilateral vision loss.

Examination revealed global choroidal effusions and a serous macular detachment in the left eye, confirmed by optical coherence tomography (OCT) and B-scan ultrasonography. Fluorescein angiography (FA) showed late macular pooling without focal leakage. All systemic medications were discontinued upon admission. Over 6 weeks, the exudative detachment resolved, and visual acuity improved from 20/800 to 20/60. At 7 months, vision remained stable at 20/60, with complete anatomical resolution of subretinal fluid with near complete resolution of ellipsoid zone (EZ) attenuation on OCT.

Overdose of selective serotonin reuptake inhibitors (SSRIs) has been associated with uveal effusion syndrome, and amphetamine-based stimulant use has been implicated in the development of central serous chorioretinopathy (CSCR). In this case, polypharmacy and overdose were associated with unilateral exudative retinal detachment and choroidal effusion, which resolved after discontinuing the offending agents.