Structural and anatomical changes in the retina due to sildenafil citrate overdose

A male patient in his early 30s presented with blurred vision, photophobia and difficulty identifying colours for 2 weeks after consuming 18 tablets of 100 mg of sildenafil citrate. During the examination, the patient's bilateral visual acuity was 20/60, and his colour and contrast vision had significantly decreased. Automated perimetry showed bilateral central visual field defects. Optical coherence tomography (OCT) revealed an irregular central ellipsoid zone (EZ) with a loss of delineation in the interdigitation zone (IZ). A diagnosis of sildenafil-overdose-induced maculopathy was made. In subsequent 6-month follow-ups, colour vision and contrast sensitivity improved, but visual field defects persisted. In OCT, we noted near normalisation of EZ and IZ. This case highlights the need to create awareness about ocular toxicity related to injudicious use of phosphodiesterase inhibitors without medical supervision.