{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T11:10:05Z","timestamp":1756379405171,"version":"3.44.0"},"reference-count":14,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,7,6]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:p>A male patient in his early 30s presented with blurred vision, photophobia and difficulty identifying colours for 2 weeks after consuming 18 tablets of 100 mg of sildenafil citrate. During the examination, the patient\u2019s bilateral visual acuity was 20\/60, and his colour and contrast vision had significantly decreased. Automated perimetry showed bilateral central visual field defects. Optical coherence tomography (OCT) revealed an irregular central ellipsoid zone (EZ) with a loss of delineation in the interdigitation zone (IZ). A diagnosis of sildenafil-overdose-induced maculopathy was made. In subsequent 6-month follow-ups, colour vision and contrast sensitivity improved, but visual field defects persisted. In OCT, we noted near normalisation of EZ and IZ. This case highlights the need to create awareness about ocular toxicity related to injudicious use of phosphodiesterase inhibitors without medical supervision.<\/jats:p>","DOI":"10.1136\/bcr-2025-265549","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T06:20:15Z","timestamp":1754029215000},"page":"e265549","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Structural and anatomical changes in the retina due to sildenafil citrate overdose"],"prefix":"10.1136","volume":"18","author":[{"given":"Rebika","family":"Dhiman","sequence":"first","affiliation":[{"name":"Ophthalmology, All India Institute of Medical Sciences New Delhi, New Delhi, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1636-1233","authenticated-orcid":false,"given":"Asmita","family":"Mahajan","sequence":"additional","affiliation":[{"name":"Ophthalmology, Dr Agarwal\u2019s Eye Hospital Ltd, Hyderabad, Telangana, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vinay","family":"Gupta","sequence":"additional","affiliation":[{"name":"Ophthalmology, All India Institute of Medical Sciences New Delhi, New Delhi, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shorya Vardhan","family":"Azad","sequence":"additional","affiliation":[{"name":"Ophthalmology, All India Institute of Medical Sciences New Delhi, New Delhi, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"key":"2025082803333514000_18.7.e265549.1","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.survophthal.2021.06.004","article-title":"Sildenafil in ophthalmology: An update","volume":"67","author":"Arora","year":"2022","journal-title":"Surv Ophthalmol"},{"key":"2025082803333514000_18.7.e265549.2","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1038\/sj.eye.6702908","article-title":"Expression of the PDE5 enzyme on human retinal tissue: new aspects of PDE5 inhibitors ocular side effects","volume":"22","author":"Foresta","year":"2008","journal-title":"Eye (Lond)"},{"key":"2025082803333514000_18.7.e265549.3","doi-asserted-by":"crossref","unstructured":"Yan H , Yu W . 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