A case of recurrent transient monocular visual loss after receiving sildenafil

Abstract

A 53-year-old man was attended to the Clinic Ophthalmic Center, Mansoura University, Egypt, with recurrent transient monocular visual loss after receiving sildenafil citrate (Viagra) for erectile dysfunction. Examination for possible risk factors revealed mild hypercholesterolemia. Family history showed that his father had suffered from bilateral nonarteritic anterior ischemic optic neuropathy (NAION). Physicians might look for arteriosclerotic risk factors and family history of NAION among predisposing risk factors before prescribing sildenafil erectile dysfunction drugs.

Figure 1

Nonarteritic anterior ischemic optic neuropathy (NAION) in the left eye of a 53-year-old man patient with a history of hypercholesterolemia. The right optic disk is pink and flat (a). Automated perimetry, using the Humphrey visual field 24-2 protocol, shows a normal visual field (b), with the dark spot in the temporal field being the physiologic blind spot. Acutely, the left optic disk appears swollen and hyperemic, with hemorrhage at the superior and temporal disk margin (c). Automated perimetry shows diffuse visual-field loss, more marked in the inferior aspect of the field (d). On review at 6 months, the optic disk swelling has resolved and the disk appears diffusely pale and atrophic (e). Automated perimetry shows improvement in the superior visual field, with a persistent inferior altitudinal defect (f).