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  • 1.  Clomed and letrozole and IIH

    Posted 17 days ago
    Has anyone seen IIH or raised ICP occur after clomed and or letrozole?

    My patient is 31yo BMI 20 malaysian indian who had normal routine eye exam 2023. I have the disc photos and they are normal

    Started clomiphene in Nov for ovulation (wants to get pregnant as she has PCOS) 5 days in Nov and 5 days in Dec2025. Then saw optom Jan2026 for routine appt. Was asymptomatic. Had bilateral grade 2-3 disc swelling ou. 
    She had LP opening pressure 34cmCSF , MRI  brain normal 
    Cease clomed and took low dose diamox 125mg bd (because 250mg bd caused her unbearable side effects).  
    Oct2025 disc swelling had come down and had stopped diamox in Jul2025.

    Started letrozole (for ovulation) Feb2026 and saw optom in Apr2026 and disc swelling was worse.
    There was no major weight gain with either of the medications. She fluctuates between 46kg to 50kg and height is about 155cm

    Ix: 
    20Oct23 OCT 112um od 108um os (not on any medications)
    4Jan25 OCT RNFL 192um od 173um os - on clomed for 2 months 
    31Oct25 OCT RNFL 120um od 119um os (not on diamox) 
    15Apr26 OCT RNFL 147um od 154um os  (on letrozole for 2 months)

    There seems to be a temporal relationship with these ovulating drugs and her disc swelling. Has anyone seen this with these two medications? I couldn't find anything in the literature


    Anthony Fok
    Neuro-ophthalmologist 
    Melbourne Health/Monash Health/Royal Victorian Eye and Ear Hospital



  • 2.  RE: Clomed and letrozole and IIH

    Posted 17 days ago
    I had a guy who took it for azoospermia . There is a few cases reported . But my patient also had high BMI so it was hard to tease it out . He calimed that he gained weight after taking it but I was not sure if it was totally true. 

    He did stop it and we used diamox - and he improved . 



    Original Message


  • 3.  RE: Clomed and letrozole and IIH

    Posted 16 days ago

    I have over the years many PTC patients with different agents used for IVF but really they are few and it seems like it rather patient susceptibility dependant rather than a fixed side effect of the drugs , I don't recall those two drugs in specific but in my precautionary paradigm any female patient going into IVF drugs or any hormonal or hormonal induction therapies with history of PTC , I just recommend close follow up with the start of therapy and with beginning pregnancy if the therapy is successful 



    Original Message


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