Sildenafil

  • Phosphodiesterase inhibitor used to treat erectile dysfunction or prolong normal erection
  • Most common ophthalmic side effect: temporary alteration in vision, presumed to be effect on retinal photoreceptors or their connections
  • Possible ophthalmic side effect: ischemic optic neuropathy
  • Ophthalmic side effects reported for all phosphodiesterase inhibitors
  • Blurred, bright, dim, blue discoloration of vision starting within 30 minutes of taking medication and ceasing within hours
  • Sudden, persistent loss of vision occurring within 24 hours of medication use, associated with swollen optic disc and afferent pupil defect in ischemic optic neuropathy
  • Temporary alteration in vision has no other explanation
  • Persistent vision loss may be caused by ischemic optic neuropathy unrelated to phosphodiesterase inhibitor use, non-ischemic optic neuropathy, or retinopathy
  • Reassure patient that alteration in vision common, temporary, and benign
  • Refer to ophthalmologist urgently any patient with persistent vision loss occurring within day of using medication
  • Warn users that ischemic optic neuropathy has been associated with phosphodiesterase inhibitor use and discourage its use in those with only one sighted eye
  • Discoloration of vision always temporary, may recur with repeated phosphodiesterase inhibitor use, but causes no permanent vision impairment
  • Ischemic optic neuropathy causes irreversible and untreatable vision loss