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 few irreversible visual outcomes have been associated with Clomiphene citrate. In this report we present a patient with presumed Clomiphene induced optic neuropathy.

Case Report

A 33-year-old man presented with acute visual loss of the right eye since a few days ago. His only medication was clomiphene citrate 100 mg daily, taken for two weeks for fertility issues. The patient presented with sudden decrease of visual acuity in the right eye on the fourteenth day of commencing the treatment, and subsequently developed complete loss of inferior visual field within days. On examination, visual acuity was 6/20, right eye, and 20/20, left eye, with a right relative afferent pupillary defect (RAPD) and decreased red saturation. Fundus examination revealed optic disc swelling with venous dilation in the right eye and a normal left fundus with a disc at risk. The patient was evaluated for cardiologic and neurologic disorders, all of which were normal. Findings were suggestive of non-arteritic anterior ischemic optic neuropathy most likely due to Clomiphene.

As Clomiphene may increase blood viscosity, it is hypothesized that reduced flow in a posterior ciliary artery caused an anterior ischemic optic neuropathy. It is advised that patients experiencing visual symptoms while taking clomiphene be examined promptly for evidence of visual changes or optic nerve injury.