A Case of Inferior Rectus Muscle Enlargement after Taking Sildenafil Citrate

Youn Hea Jung; Na Young Lee; Hye Bin Yim

doi:10.3341/jkos.2013.54.2.382

Journal List > J Korean Ophthalmol Soc > v.54(2) > 1009608

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Jung, Lee, and Yim: A Case of Inferior Rectus Muscle Enlargement after Taking Sildenafil Citrate

Original Article

J Korean Ophthalmol Soc 2007;54(2):382-386.

Published online: 24 August 2007

DOI: https://doi.org/10.3341/jkos.2013.54.2.382

A Case of Inferior Rectus Muscle Enlargement after Taking Sildenafil Citrate

Youn Hea Jung, MD, Na Young Lee, MD, PhD, Hye Bin Yim, MD, PhD

Department of Ophthalmology, The Catholic University of Korea Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea

Address reprint requests to Hye Bin Yim, MD, PhD Department of Ophthalmology, The Catholic University of Korea Incheon St. Mary's Hospital #56 Dongsu-ro, Bupyeong-gu, Incheon 403-720, Korea Tel: 82-32-280-5885, Fax: 82-32-280-5833, E-mail: yimhb@catholic.ac.kr

Received 10 February 20126 October 2012 Accepted 15 December 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Myositis, Sildenafil citrate, Strabismus, Viagra

References

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Figure 1.

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

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.

Table 1.

The Naranjo adverse drug reaction probability scale

	Yes	No	Do not know	Score
1. Are there previous conclusive reports on this reaction?	+1	0	0	0
2. Did the adverse event occur after the suspected drug was administered?	+2	−1	0	+2
3. Did the adverse reaction improve when the drug was discontinued or a specific antagonist was administered?	+1	0	0	+1
4. Did the adverse reaction reappear when the drug was readministered?	+2	−1	0	0
5. Are there alternative causes (other than the drug) that could have on their own caused the reaction?	−1	+2	0	+2
6. Did the reaction reappear when a placebo was given?	−1	+1	0	0
7. Was the blood detected in the blood (or other fluids) in concentrations known to be toxic?	+1	0	0	0
8. Was the reaction more severe when the dose was increased or less severe when the dose was decreased?	+1	0	0	0
9. Did the patient have a similar reaction to the same or similar drugs in any previous exposure?	+1	0	0	0
10. Was the adverse event confirmed by any objective evidence?	+1	0	0	+1
Assessment score:			Total	6

Definite ≥ 9; Probable 5-8; Possible 1-4; doubtful ≤ 0.

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