Ocular Events Temporally Associated With Minoxidil: A Structured Review

Minoxidil is widely used in topical form for androgenetic alopecia and is increasingly prescribed orally for hair disorders. Although cardiovascular and dermatologic adverse effects are well recognized, ocular complications associated with minoxidil exposure remain poorly characterized in the dermatologic literature. We conducted a structured review of published papers describing ocular adverse events temporally associated with oral or topical minoxidil (TM) use, following PRISMA guidelines. Twelve papers were identified, with a mean patient age of 33 years and predominance of male patients (83%). Exposure involved TM in 75% of cases, oral minoxidil in 8%, and combined use in 17%. Central serous chorioretinopathy was the most frequently reported event (58%), followed by retinal vascular occlusion (17%), nonarteritic anterior ischemic optic neuropathy (8%), ocular hypertension (8%), and transient optic nerve-associated visual disturbance (8%). Diagnostic confirmation was reported in all cases (100%). Discontinuation of minoxidil occurred in most cases (92%) and was frequently associated with clinical or anatomic improvement (83%); however, causality remained uncertain based on WHO-UMC and modified Naranjo assessments, with most cases categorized as possible adverse drug reactions. These findings highlight a rare but clinically relevant spectrum of ocular events temporally associated with minoxidil use. Clinicians should counsel patients to report new visual symptoms and consider ophthalmologic evaluation when indicated. Larger pharmacovigilance and observational studies are needed to better define incidence and underlying mechanisms.