IMPORTANCE: Sickle cell disease (SCD) is characterized by vaso-occlusive crisis. 
In the eye, central retinal artery occlusion (CRAO) is a rare complication in 
SCD, with only 1 previous report of bilateral, concurrent CRAO. We report a case 
of bilateral, concurrent CRAO in a patient with SCD, possibly precipitated by 
the use of phosphodiesterase 5 inhibitors.
OBSERVATIONS: A 37-year-old African American woman with a known medical history 
significant for SCD and pulmonary arterial hypertension who was receiving 
treatment with tadalafil, a phosphodiesterase 5 inhibitor, developed bilateral, 
concurrent CRAO that persisted after exchange transfusion.
CONCLUSIONS AND RELEVANCE: Bilateral CRAO secondary to SCD is extremely rare, 
with only 1 previous case report in the literature. The use of phosphodiesterase 
5 inhibitors is an additional risk factor and may have contributed to the 
development of concurrent CRAO in this patient.