Central Retinal Artery Occlusion Associated with Sildenafil Overdose

Area of Science:

• Ophthalmology
• Pharmacology

Background:

• Central retinal artery occlusion (CRAO) is a critical condition causing sudden vision loss.
• Sildenafil, a phosphodiesterase-5 inhibitor, is commonly used for erectile dysfunction.

Observation:

• A 42-year-old male presented with acute, painless vision loss in one eye.
• Fundus examination revealed characteristic signs of CRAO, including retinal whitening and a cherry-red spot.
• The patient reported consuming a high dose of sildenafil (200 mg) within a 24-hour period prior to symptom onset.

Findings:

• The patient was diagnosed with CRAO with cilioretinal artery sparing.
• Despite no identified emboli, anterior chamber paracentesis was performed.
• Visual acuity improved to 20/80 with resolution of retinal edema after four weeks.
• Extensive workup excluded other predisposing factors for CRAO.

Implications:

• This case suggests a potential association between sildenafil overdose and CRAO.
• Physicians should consider medication history, including recent high-dose sildenafil use, in patients presenting with CRAO.
• Further research is warranted to elucidate the mechanism and confirm the link between sildenafil overdose and retinal vascular events.