J Korean Ophthalmol Soc.  2013 Feb;54(2):382-386. 10.3341/jkos.2013.54.2.382.

A Case of Inferior Rectus Muscle Enlargement after Taking Sildenafil Citrate

• Jung YH
• Lee NY
• Yim HB

• KMID: 2216679
• DOI: http://doi.org/10.3341/jkos.2013.54.2.382

Abstract

PURPOSE
Sildenafil citrate was developed to treat angina, but was found to also inhibit PDE in the corpus callosum and is now widely used to treat impotence. We report a case of enlargement of the inferior rectus muscle after sildenafil citrate ingestion.
CASE SUMMARY
A 58-year-old male presented with binocular diplopia which started 2 weeks prior. He had no underlying disease. The patient had taken sildenafil citrate on 3 different occasions 2 weeks prior, and 2 days after his first ingestion, his right conjunctiva was injected and binocular diplopia started. On the first visit, he showed 16 PD hypotropia of the right eye with limitation of motion at upgaze. The MRI scan showed enlargement and enhancement of the inferior rectus muscle, and 50 mg of prednisone was prescribed. The amount of hypotropia decreased to 8 PD 2 weeks later.
CONCLUSIONS
Enlargement of extraocular muscle caused by sildenafil citrate ingestion has not been reported in Korea, and related mechanisms are yet to be researched. Additional case reports and research are necessary in the future.

Keyword

Myositis; Sildenafil citrate; Strabismus; Viagra

MeSH Terms

Citric Acid
Conjunctiva
Corpus Callosum
Diplopia
Eating
Erectile Dysfunction
Eye
Humans
Korea
Magnetic Resonance Imaging
Male
Muscles
Myositis
Piperazines
Prednisone
Purines
Strabismus
Sulfones
Telescopes
Sildenafil Citrate
Citric Acid
Piperazines
Prednisone
Purines
Sulfones

Figure

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  Figure 1. The patient shows 16 PD of right hypotropia and upper gaze limitation.

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  Figure 2. Axial (A), coronal (B), sagittal (C, D) M RI images show enlargement and enhancement of the inferior rectus muscle of the right eye. There is no enlargement of the extraocular muscles of the left eye.

Reference

References

1. Marmor MF, Kessler R. Sildenafil (Viagra) and ophthalmology. Surv Ophthalmol. 1999; 44:153–62.

2. Sivaswamy L, Vanstavern GP. Ischemic optic neuropathy in a child. Pediatr Neurol. 2007; 37:371–2.

3. Tripathi A, O'Donnell NP. Branch retinal artery occlusion; another complication of sildenafil. Br J Ophthalmol. 2000; 84:934–5.

4. Donahue SP, Taylor RJ. Pupil-sparing third nerve palsy associated with sildenafil citrate (Viagra). Am J Ophthalmol. 1998; 126:476–7.

5. Jang YS, Ahn GS, Kim SD. Retinal hemorrhage associated with viagra (sildenafil citrate). J Korean Ophthalmol Soc. 2002; 43:1340–4.

6. Fraunfelder FW, Pomeranz HD, Egan RA. Nonarteritic anterior ischemic optic neuropathy and sildenafil. Arch Ophthalmol. 2006; 124:733–4.

7. Laties AM. Vision disorders and phosphodiesterase type 5 inhibitors: a review of the evidence to date. Drug Saf. 2009; 32:1–18.

8. Lee WJ, Seong M. Bilateral simultaneous acute angle closure glaucoma following sexual intercourse aided by sildenafil citrate. J Korean Ophthalmol Soc. 2011; 52:1123–7.

9. Lee JS, Oum BS, Choi CH, Kim HJ. Clinical study of the idiopathic orbital myositis. J Korean Ophthalmol Soc. 1999; 40:1109–15.

10. Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981; 30:239–45.

11. Kim CH, Lim JY, Ahn JH, Jang JW. A case of idiopathic orbital myositis involving all extraocular muscles of both eyes. J Korean Ophthalmol Soc. 2001; 42:1615–20.

12. Mombaerts I, Koornneef L. Current status in the treatment of orbital myositis. Ophthalmology. 1997; 104:402–8.

13. Weinstein GS, Dresner SC, Slamovits TL, Kennerdell JS. Acute and subacute orbital myositis. Am J Ophthalmol. 1983; 96:209–17.

14. Subramanian PS, Kerrison JB, Calvert PC, Miller NR. Orbital inflammatory disease after pamidronate treatment for metastatic prostate cancer. Arch Ophthalmol. 2003; 121:1335–6.

15. Phillips PM, Newman SA. Orbital inflammatory disease after intravenous infusion of zoledronate for treatment of metastatic renal cell carcinoma. Arch Ophthalmol. 2008; 126:137–9.