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Alizadeh, Y., Moravvej, Z., Khakpour, Y., Azaripour, E., Akbari, M., & Soltani-Moghadam , R. (2021). Presumed clomiphene-induced optic neuropathy: A case report. International Journal of Reproductive BioMedicine (IJRM), 19(5), 471–476. https://doi.org/10.18502/ijrm.v19i5.9257

https://doi.org/10.18502/ijrm.v19i5.9257

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authors

  • Yousef Alizadeh

    Yousef Alizadeh

    Department of Eye, Eye Research Center, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
  • Zahra Moravvej

    Zahra Moravvej

    Department of Eye, Eye Research Center, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
  • Yaser Khakpour

    Yaser Khakpour

    Department of Eye, Eye Research Center, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
  • Ebrahim Azaripour

    Ebrahim Azaripour

    Department of Eye, Eye Research Center, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
  • Mitra Akbari

    Mitra Akbari

    Department of Eye, Eye Research Center, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
  • Reza Soltani-Moghadam

    Reza Soltani-Moghadam

    Department of Eye, Eye Research Center, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
    https://orcid.org/0000-0001-9661-3036

Published Date

  • Jun 23, 2021

Presumed clomiphene-induced optic neuropathy: A case report

International Journal of Reproductive BioMedicine (IJRM) / International Journal of Reproductive BioMedicine (IJRM): Volume 19, Issue No. 5 / Pages 471–476

Abstract

Background: Clomiphene citrate is an estrogen receptor ligand with mixed agonistic–antagonistic properties used for the treatment of female and male infertility. Various visual disturbances and several irreversible visual outcomes have been associated with clomiphene citrate. In this report, we present a patient with presumed clomiphene-induced optic neuropathy.


Case: A 33-yr-old man with acute visual loss of the right eye was referred to Amiralmomenin Hospital, Rasht, Iran in November 2018. His only medication was clomiphene citrate 100 mg daily, taken for 2 wk for fertility issues. The patient presented with a sudden decrease of visual acuity in the right eye on the 14th day of starting the treatment and subsequently developed complete loss of inferior visual field within a few days. On examination, the visual acuity was 6/20 in the right and 20/20 in the left eyes, with a right relative afferent pupillary defect and decreased red color saturation. The fundus examination revealed optic disc swelling with venous dilation in the right eye and a normal left fundus with a crowded disc (disc-at-risk). The patient was evaluated for systemic disorders, all of which were normal. Findings were suggestive of non-arteritic anterior ischemic optic neuropathy most likely due to clomiphene.


Conclusion: As clomiphene may increase blood viscosity, it is hypothesized that reduced flow in a posterior ciliary artery in conjunction with the disc-at-risk contributes to the anterior ischemic optic neuropathy. It is advised that patients with disc-at-risk be aware of the possible non-arteritic anterior ischemic optic neuropathy and those experiencing visual symptoms while taking clomiphene be examined promptly for evidence of optic nerve injury.


Key words: Clomiphene citrate, Optic neuropathy, Visual acuity, Ischemia.

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