Focal choroidal excavation and choroidal neovascular membrane following sildenafil intake

Sildenafil citrate is widely abused as a recreational drug. The ocular side effects of this drug are often overlooked, because they tend to be mild and transient. Commonly reported side effects include light sensitivity and dyschromatopsia resulting in impairment of blue-green discrimination. We present a rare occurrence of a focal choroidal excavation (FCE) in a healthy 34-year-old Asian Indian man after sildenafil intake. Sudden diminution of vision was noted a day after taking 50 mg/day sildenafil for 3 consecutive days. An FCE was seen on the optical coherence tomography in the left eye, with visual acuity of 20/30. Choroidal and outer retinal layers were disturbed superior to the fovea. Color vision disturbance was also noted. A choroidal neovascular membrane developed after 8 months, which was treated with ranibizumab injection. Final visual acuity was 20/80, due to macular scarring in the left eye. Sildenafil has been shown to cause choroidal thickening. We hypothesize that the sudden turgescence of the choroid might have led to the FCE.