Stress Vasoreactivity Chorioretinopathy: A Bilateral, Reversible Choroidal Hypoperfusion After Systemic Trauma without Direct Ocular Injury

PURPOSE: To describe a stress-related choroidopathy presenting as bilateral subretinal fluid (SRF) and choroidal hypoperfusion after a traffic accident without direct ocular injury, with rapid recovery following vasodilator therapy. METHODS: Retrospective case report with multimodal imaging, including color fundus, fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), optical coherence tomography angiography (OCTA) and clinical course. RESULTS: A 48-year-old man experienced profound bilateral visual loss after head and facial trauma. The initial diagnosis made at an outside hospital was "bilateral optic nerve injury." On presentation at our clinic, OCT revealed substantial macular SRF in both eyes (OU) while fluorescein angiography (FA) was unremarkable. ICGA demonstrated mid- to late-phase patchy hypofluorescence corresponding to the areas of SRF. The patient was treated with intravenous alprostadil (prostaglandin E1, 5 µg daily) plus subcutaneous compound anisodine (0.2 mg daily). SRF resolved in the right eye (OD) by day 1 and in the left eye (OS) by day 3. By week 3, best-corrected visual acuity (BCVA) improved to 0.9 OD and 0.8 OS; ICGA hypofluorescence resolved; OCTA demonstrated qualitative increases in choroidal vessel volume (CVV), choroidal stromal volume (CSV), and choroidal thickness. CONCLUSIONS: We propose Stress Vasoreactivity Chorioretinopathy (SVC)-a transient, sympathetic-mediated choroidal vasoconstriction causing segmental hypoperfusion, secondary retinal pigment epithelium (RPE) pump failure, and SRF. In post-traumatic visual loss without ocular impact, early multimodal imaging and vasodilator therapy may expedite recovery.