Cilioretinal Artery Occlusion Associated With Subcutaneous Testosterone Replacement Therapy

Purpose: To report a case of non-arteritic cilioretinal artery occlusion associated with subcutaneous testosterone pellet therapy in a perimenopausal woman. Methods: A single case was reviewed. Results: A 48-year-old woman presented to the emergency department with an acute central "gray spot" in her left eye that began 6 hours before presentation. Fundus examination revealed intraretinal whitening of the inferior macula along the distribution of the cilioretinal artery, with foveal sparing. Systemic evaluation, including stroke and hypercoagulability work-up, was negative. The patient's history was notable for active treatment with subcutaneous testosterone pellets and prior retinal migraines. Over a 6-week follow-up period, the visual field defect persisted but showed improvement, and the intraretinal whitening resolved completely. Conclusions: This case suggests a possible association between subcutaneous testosterone therapy and non-arteritic cilioretinal artery occlusion in the absence of identifiable thrombophilia or hypofibrinolysis. Clinicians should consider counseling patients and screening before initiating testosterone therapy, given the potential risk of venous and arterial thromboembolism.