When Erectile Dysfunction Therapy Clouds the Vision: Central Serous Chorioretinopathy after Sildenafil in a Healthy Male

Central serous chorioretinopathy (CSCR) is a pachychoroid-spectrum disorder characterized by serous neurosensory retinal detachment secondary to choroidal vascular congestion and retinal pigment epithelial dysfunction. While corticosteroid use and psychological stress are well-established risk factors, phosphodiesterase type-5 inhibitors such as sildenafil citrate, widely used for erectile dysfunction, have been increasingly recognized as an under-reported pharmacological trigger, with proposed mechanisms involving acute choroidal vasodilation and hyperpermeability. A 39-year-old previously healthy male presented with sudden, painless diminution of vision in the right eye of 48 h, occurring shortly after ingestion of a single large recreational dose of sildenafil citrate. Best-corrected visual acuity was reduced to 6/18 in the right eye, with a normal left eye. Fundus examination revealed a well-demarcated serous macular elevation, and optical coherence tomography (OCT) confirmed a dome-shaped neurosensory detachment with a markedly elevated central subfield thickness. A comprehensive systemic and hematological workup, including thrombophilia screening and cardiac evaluation, was unremarkable, supporting a diagnosis of sildenafil-induced CSCR. The patient was managed conservatively with topical nepafenac, topical Flurbiprofen, and oral alcaftadine, along with cessation of further sildenafil use. Serial follow-up over approximately 2 months demonstrated progressive resolution of subretinal fluid, normalization of central subfield thickness, and preservation of visual acuity, with OCT angiography confirming adequate perfusion and no neovascular complication. This case reinforces sildenafil as a potential, dose-related precipitant of acute CSCR even after a single high dose in patients without conventional risk factors. Prompt recognition, drug cessation, and conservative management resulted in complete anatomical and visual recovery, highlighting the importance of a thorough medication history in young patients presenting with unexplained central visual disturbance.