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Abstract Details

Sildenafil Induced Headache and Blurry vision
Neuro-ophthalmology/Neuro-otology
P6 - Poster Session 6 (12:00 PM-1:00 PM)
5-007
A wide range of conditions can present with headaches and blurred vision. Migraine and increased intracranial pressure are among the most common causes. However, when visual symptoms are atypical for a headache syndrome, other etiologies should be considered. 
We report a case of worsening headaches and occult vision loss in a patient with pulmonary hypertension.
Case report

A 47-year-old female with pulmonary hypertension presented with headaches and vision changes progressing over 1 year. She had difficulty focusing because her vision was a “total blur” with black dots all over the visual fields. She had no double vision, sudden onset vision loss, pain with eye movement, or transient visual obscuration. Medications included sildenafil and visual changes worsened with increased sildenafil dose. On exam, her best-corrected visual acuity decreased to 20/30 in each eye. The pupil exam was normal without relative afferent pupillary defect. The ocular motility was normal and there was no misalignment.  Her fundus exam was normal with healthy optic nerves and maculae in each eye. Goldmann visual field showed full field in the right eye and generalized mild constriction in the left eye. MRI brain was normal. Full field electroretinography (ERG) showed normal amplitude, wave form, and timing. Multi-focal ERG showed blunting of the foveal peaks in both eyes, with focal depression in the macula, more prominent in the left eye. A diagnosis of presumed sildenafil associated maculopathy coincidental with primary headache syndrome was made. After discussion with her pulmonologist, sildenafil was discontinued. At 2 months follow-up, her headaches improved, and visual symptoms were stable. 

Vision changes can be separate from a headache syndrome. In our patient, sildenafil was associated with progressive vision loss due to maculopathy, which was unrelated to worsened primary headaches. In patient with pulmonary hypertension, the decision to discontinue sildenafil should be made with Pulmonology.

Authors/Disclosures
Yin Allison Liu, MD (UC Davis)
PRESENTER
Dr. Liu has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Myrobalan. Dr. Liu has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx.
Jose Davila No disclosure on file
Heather Moss, MD, PhD, FAAN (Spencer Center for Vision Research at Stanford) Dr. Moss has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Twenty Twenty Therapeutics. Dr. Moss has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Verana Health. Dr. Moss has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Medlink Inc. Dr. Moss has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Legal Firms. The institution of Dr. Moss has received research support from NIH. The institution of Dr. Moss has received research support from Department of Defense. The institution of Dr. Moss has received research support from Research to Prevent Blindness. Dr. Moss has received intellectual property interests from a discovery or technology relating to health care. Dr. Moss has received personal compensation in the range of $0-$499 for serving as a grant review panel with NASA. Dr. Moss has received personal compensation in the range of $0-$499 for serving as a grant review panel with National Institutes of Health. Dr. Moss has a non-compensated relationship as a Board of Directors with North American Neuro-ophthalmology Society that is relevant to AAN interests or activities.