Tadalafil-induced subretinal and choroidal hemorrhage in a patient with an unsuspected uveal (choroidal and ciliary body) melanoma.

rhages bilaterally. An old atrophic scar was noted in the left macula, with the right macula appearing normal. There were no vitreal snow balls, snow banking, punched-out chorioretinal scars, nor any other complications. Investigations included a full blood examination and film, calcium levels, syphilis serology, angiotensin-converting enzyme assay, chest radiography, and HLAA29 typing. All results were normal except for the HLA-A29 typing, which was positive. Electrophysiology revealed delayed scotopic blue and photopic red b wave amplitudes. Fluorescein angiography revealed areas of vasculitis and typical late staining of the birdshot lesions. Six months prior to the onset of symptoms, the patient, who works in an eye research institution, volunteered to have his fundi photographed for staff training purposes. Review of these photographs revealed his preexisting left macular scar and the presence of the typical depigmented birdshot choroidopathy lesions, retinal hemorrhages, and patchy retinal vasculitis (Figure 2).