Background: Bullous central serous chorioretinopathy (bCSC) is an atypical variant of central serous chorioretinopathy (CSC), characterized by exudative retinal detachment (RD). We report a case of bCSC successfully treated with external drainage and vitrectomy. Case presentation: A 51-year-old male presented with blurred vision in right eye. Inferior bullous RD was found without retinal breaks. Shifting of subretinal fluid was observed. Fluorescein angiography revealed inferonasal main leaking point. Optical coherence tomography revealed retinal pigment epithelial tear that corresponded to the main leaking point. Laser photocoagulation at leaking points was performed. Exudative RD was extended and prominent. Photodynamic therapy was considered ineffective and impossible. Eighteen days after the first visit, external drainage, vitrectomy with perfluorocarbon liquid, endolaser and intravitreal sulfur hexafluoride gas injection were performed. Retina was flat and maintained for 2 years and 4 months. Conclusion: Exudative RD can be an atypical presentation of CSC. External drainage can be considered as safe and effective treatment for bCSC.