Toremifene-induced bilateral macular crystalline deposits with cystic cavitation: a case report

Chunhuan Niu, Fang Wang, Jiao Li, Xiaotong Sun, Xiaofeng Xie, Yane Gao

Tamoxifen-induced retinopathy is well recognized and frequently reported in clinical practice. By contrast, ocular adverse events associated with the structurally similar agent toremifene remain rarely described. We present a case of bilateral visual impairment in a patient receiving long-term oral toremifene citrate for secondary prevention after breast cancer surgery. Ophthalmic evaluation showed yellowish-white crystalline deposits within the macular retinal layers in both eyes. Optical coherence tomography (OCT) revealed cystic vacuolization in the bilateral foveal regions, with features closely resembling tamoxifen-induced retinopathy. A clinical diagnosis of toremifene-associated retinopathy was established. This case may provide reference for clinicians when judging the appropriate timing of toremifene withdrawal. Should drug cessation be considered, a joint assessment by ophthalmologists and oncologists should be performed to balance the risks of tumor progression and ocular damage before reaching a clinical decision. In addition, this case supplements available evidence regarding toremifene-related ocular toxicity and raises clinical awareness of this condition.