Articles about Eye Health and Disease 2002
 

Sildenafil (Viagra) Use Associated with Ischemic Optic Neuropathy (stroke of the optic nerve)

(From Pomeranz HD, Ophthalmology 2002;109:584-587.)

Sildenafil citrate (Viagra) has been widely prescribed for erectile dysfunction in men.  The drug leads to relaxation of the smooth muscle fibers allowing inflow of blood during sexual stimulation.  Ocular side effects with the drug include increased sensitivity to light, a bluish tinge to the vision, pupil dilation, blurred vision, conjunctivitis, eye pain, eye hemorrhage, ocular redness, retinal vascular bleeding, and others.  There are few reports in the ophthalmic literature concerning this drug.  In the report cited above, 5 cases of non-arteritic anterior ischemic optic neuropathy associated with sildenafil use are described.

Anterior ischemic optic neuropathy is caused by an acute loss of blood flow to the optic nerve where is enters the eye (optic disc).  This can lead to a severe loss of vision, blind spots in the vision, and blurred vision.  It is usually painless.  In the study, the ischemic optic neuropathy occurred within minutes to hours of ingesting the drug.  Four of the five patients had no other risk factors for ischemic optic neuropathy.  All patients developed blurred vision in one eye, a loss in the lower field of peripheral vision, and swelling of the optic nerve on examination.  All patients were noted to have a small cup-to-disc ratio of the optic nerve.

• One patient (52 years of age) retained 20/20 vision, but had a persistent loss of the lower half of his vision in one eye 9 months after the event.

• One patient (69 years of age) had a persistent reduction of vision in one eye of 20/80, with a blind spot in the lower inside field of vision.

• One patient (42 years of age) had a reduction of vision to 20/200 in one eye, with hemorrhages of the optic nerve and a loss of the lower field of vision in the eye.

• One patient (62 years of age) had a history of ischemic optic neuropathy in one eye.  Following use of sildenafil, a new visual field blind spot in the lower field of vision of the previously unaffected eye developed, with a visual acuity of 20/50.

• One patient (59 years of age) retained 20/25 vision, but developed a blind spot in the lower half of his field of vision in one eye.  He also had a history of coronary artery disease and diabetes.

The investigators concluded that sildenafil citrate may be associated with anterior ischemic optic neuropathy, and a small cup-to-disc ratio may be a risk factor.

 

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