Association between Clomiphene Citrate and Visual Disturbances with Special Emphasis on Central Retinal Vein Occlusion: A Review

Viola, M.I.; Meyer, David; Kruger, Thinus F.

doi:10.1159/000319497

Cited by 26 publications

(26 citation statements)

References 30 publications

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“…Thrombophilia associated with exogenous estrogens,6 estrogen progestin oral contraceptives, 7 clomiphene citrate,8 or selective estrogen receptor modulators (SERMS)9 may promote CRVO,8,10–14 AF,9,15–17 and CRAO 18–20. Most studies associating estrogen–progestin oral contraceptives with CRVO or CRAO are case reports of only one to three cases 18,21–23.…”

Section: Introductionmentioning

confidence: 99%

Thrombophilia and retinal vascular occlusion

Glueck¹,

Hutchins²,

Jurantee³

et al. 2012

OPTH

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PurposeThe purpose of this research was to assess associations of thrombophilia with central retinal vein occlusion (CRVO), central retinal artery occlusion (CRAO), and amaurosis fugax (AF); to evaluate outcomes of normalizing high homocysteine; and to study CRVO, CRAO, and AF developing in estrogens/estrogen agonists in women subsequently shown to have thrombophilia.MethodsMeasures of thrombophilia–hypofibrinolysis were obtained in 132 CRVO cases, 15 CRAO cases, and 17 AF cases. Cases were compared to 105 healthy control subjects who did not differ by race or sex and were free of any ophthalmologic disorders. All cardiovascular disease (CVD) risk factors were compared to healthy general populations.Main outcome measuresThe main outcome measure of this study was thrombophilia.ResultsCRVO cases were more likely than controls to have high homocysteine (odds ratio [OR] 8.64, 95% confidence intervals [CI]: 1.96–38), high anticardiolipin immunoglobulin M (IgM; OR 6.26, 95% CI: 1.4–28.2), and high Factor VIII (OR 2.47, 95% CI: 1.31–7.9). CRAO-AF cases were more likely than controls to have high homocysteine (OR 14, 95% CI: 2.7–71.6) or the lupus anticoagulant (OR 4.1, 95% CI: 1.3–13.2). In four of 77 women with CRVO (two found to have high homocysteine, two with inherited high Factor XI), CRVO occurred after starting estrogen–progestins, estrogen–testosterone, or estrogen agonists. In one of eight women with CRAO found to have high anticardiolipin antibody IgG, CRAO occurred after starting conjugated estrogens, and AF occurred after starting conjugated estrogens in one of eleven women with AF (inherited protein S deficiency). Therapy for medians of 21 months (CRVO) and 6 months (CRAO-AF) was 5 mg folic acid, 100 mg B6, and 2000 mcg/day B12 normalized homocysteine in 13 of 16 (81%) CRVO cases and all five CRAO-AF cases with pretreatment hyperhomocysteinemia. The CRVO cases had an excess of hypertension; CRAO-AF cases had an excess of type 2 diabetes and hypertension.ConclusionTreatable thrombophilia, hyperhomocysteinemia in particular, is more common in RVO cases than in normal controls. RVO occurs after estrogens or estrogen agonists were administered in women subsequently shown to have thrombophilia.

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Section: Introductionmentioning

confidence: 99%

Thrombophilia and retinal vascular occlusion

Glueck¹,

Hutchins²,

Jurantee³

et al. 2012

OPTH

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“…Thus, estrogen can directly or indirectly stimulate the visual cortex, thus triggering the development of visual hallucinations. CC causes ocular side effects such as central retinal vein occlusion, irreversible palinopsias, optic neuropathy, anterior uveitis, and maculopathy [6–10]. Purvin [7] described visual hallucinations in three women treated for infertility with CC for 4 to 15 months.…”

Section: Discussionmentioning

confidence: 99%

Clomiphene citrate-induced visual hallucinations: a case report

et al. 2017

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Background: Polycystic ovary syndrome is a common cause of chronic anovulation and infertility in otherwise healthy fertile couples. Clomiphene citrate is used as a first-line ovulation induction therapy in patients with polycystic ovary syndrome. Clomiphene citrate can cause both systemic and ocular side effects. We report a rare side effect of illusory palinopsias in a patient with polycystic ovary syndrome treated with ovulation induction therapy with clomiphene citrate, and emphasize the need for gynecologists and their patients to be aware of this rare ocular side effect. Case presentation: A 30-year-old Asian woman complained of persistent visual afterimages following treatment with 100 mg clomiphene citrate for anovulation. Her symptoms started on the fourth day after commencing the treatment and would last for 5 to 10 minutes. Similar visual symptoms were noted during her second cycle of treatment with clomiphene citrate. The severity of her symptoms reduced following the stoppage of the medication; however, the symptoms have persisted for more than 1 year since she stopped taking the drug. Conclusions: Clomiphene citrate can cause disturbing illusory palinopsias. These afterimages persist even after stopping the infertility medication. It is a side effect not frequently seen by gynecologists or ophthalmologists. Gynecologists should make their patients aware of this rare ocular side effect when their patients start treatment with clomiphene citrate for infertility.

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“…A computerized PubMed search made by Viola MI et al [5] found only four articles that describe visual problems with Clomifene citrate in fertility patients and were published as case reports. They also found two systematic reviews on the adverse effects of Clomifene and found no visual changes.…”

Section: Discussionmentioning

confidence: 99%

“…Clomifene Citrate has been associated with visual problems, especially with increased dosage or duration of therapy [2]. Visual problems like blurred vision, photophobia, diplopia, scotomata, phosphenes, periphlebitis, central retinal vein occlusion, optic neuropathy and palinopsias has been associated with clomiphene citrate [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Blindness and retinal disorder associated with clomifene citrate: Cases series assessment

Russom¹,

Bastola²,

Zeregabr³

et al. 2017

Clin Med Invest

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Background: Clomifene Citrate has been associated with various visual disturbances. However, we found no published study that associate Clomifene citrate and blindness. The Eritrean Pharmacovigilance Centre received one case of retinal detachment while on use of Clomifene citrate that caused irreversible blindness. Hence, the purpose of this study is to assess the causal relationship between Clomifene citrate and blindness in general and retinal detachment in particular.

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Association between Clomiphene Citrate and Visual Disturbances with Special Emphasis on Central Retinal Vein Occlusion: A Review

Cited by 26 publications

References 30 publications

Thrombophilia and retinal vascular occlusion

Thrombophilia and retinal vascular occlusion

Clomiphene citrate-induced visual hallucinations: a case report

Blindness and retinal disorder associated with clomifene citrate: Cases series assessment

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