Bilateral Simultaneous Nonarteritic Anterior Ischemic Optic Neuropathy Associated with The Use of Sildenafil: A Case Report

Author

Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

Abstract

Abstract Introduction: Nonarteritic anterior ischemic optic neuropathy (NAION) is a rare condition but one of the most important ocular side effects of sildenafil. Case Presentation:We presented a 65-year- old man with the history of sudden painless loss of vision in both eyes following taking sildenafil. Conclusions: Fundus examination revealed blurred margin and elevated disc in both eyes. Visual field defects were bilateral inferior altitudinal defects, and optical coherence tomography (OCT) displayed a prominent nerve fiber layer edema in both eyes. We asserted that use of sildenafil may lead to reduce blood pressure and interfere with microcirculation in the optic nerve head. So, the potential risks of unregulated over-the-counter sexual enhancement supplements such as sildenafil must be educated to the patients using these supplements.

Keywords


  1. 1.Gorkin L, Hvidsten K, Sobel RE, Siegel R. Sildenafil citrate use and the incidence of nonarteritic anterior ischemic optic neuropathy. Int J Clin Pract. 2006;60(4):500–3. doi: 10.1111/j.1368-5031.2006.00904.x. [PubMed: 16620369].

    1. Hayreh SS. Non-arteritic anterior ischaemic optic neuropathy and phosphodiesterase-5 inhibitors. Br J Ophthalmol. 2008;92(12):1577–80. doi: 10.1136/bjo.2008.149013. [PubMed: 19029161].
    2. Laties AM. Vision disorders and phosphodiesterase type 5 inhibitors: a review of the evidence to date. Drug Saf. 2009;32(1):1–18. doi: 10.2165/00002018-200932010-00001. [PubMed: 19132801].
    3. Pomeranz HD, Smith KH, Hart WM Jr, Egan RA. Sildenafil-associated nonarteritic anterior ischemic optic neuropathy. Ophthalmology. 2002;109(3):584–7. doi: 10.1016/S0161-6420(01)00976-9. [PubMed: 11874765].
    4. Fraunfelder FW. Visual side effects associated with erectile dysfunction agents. Am J Ophthalmol. 2005;140(4):723–4. doi: 10.1016/j.ajo.2005.02.049. [PubMed: 16226525].
    5. Egan RA, Fraunfelder FW. Viagra and anterior ischemic optic neuropathy. Arch Ophthalmol. 2005;123(5):709–10. doi: 10.1001/archopht.123.5.709-b. [PubMed: 15883302].
    6. Beri M, Klugman MR, Kohler JA, Hayreh SS. Anterior ischemic optic neuropathy. VII. Incidence of bilaterality and various influencing factors. Ophthalmology. 1987;94(8):1020–8. doi: 10.1016/S0161- 6420(87)33350-0. [PubMed: 3658362].
    7. Hayreh SS, Podhajsky PA, Zimmerman B. Nonarteritic anterior ischemic optic neuropathy: time of onset of visual loss. Am J Ophthalmol. 1997;124(5):641–7. doi: 10.1016/S0002-9394(14)70902-X. [PubMed: 9372718].
    8. Arnold AC, Hepler RS. Natural history of nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol. 1994;14(2):66–9. doi: 10.1097/00041327-199406000-00002. [PubMed: 7951929]. 10. Mathews MK. Nonarteritic anterior ischemic optic neuropathy. Curr Opin Ophthalmol. 2005;16(6):341–5. doi: 10.1097/01.icu.0000188361.52166.93. [PubMed: 16264343].
    9. Boghen DR, Glaser JS. Ischaemic optic neuropathy. The clinical profile and history. Brain. 1975;98(4):689–708. doi: 10.1093/brain/98.4.689. [PubMed: 1218373].
    10. Escaravage GK Jr, Wright JD Jr, Givre SJ. Tadalafil associated with anterior ischemic optic neuropathy. Arch Ophthalmol. 2005;123(3):399– 400. doi: 10.1001/archopht.123.3.399. [PubMed: 15767487].
    11. Pomeranz HD, Bhavsar AR. Nonarteritic ischemic optic neuropathy developing soon after use of sildenafil (Viagra): a report of seven new cases. J Neuroophthalmol. 2005;25(1):9–13.
    12. Fraunfelder FW, Pomeranz HD, Egan RA. Nonarteritic anterior ischemic optic neuropathy and sildenafil. Arch Ophthalmol. 2006;124(5):733–4. doi: 10.1001/archopht.124.5.733. [PubMed: 16682597].
    13. Margo CE, French DD. Ischemic optic neuropathy in male veterans prescribed phosphodiesterase-5 inhibitors. Am J Ophthalmol. 2007;143(3):538–9. doi: 10.1016/j.ajo.2006.10.006. [PubMed: 17317413].
    14. Hayreh SS. Erectile dysfunction drugs and non-arteritic anterior ischemic optic neuropathy: is there a cause and effect relationship?. J Neuroophthalmol. 2005;25(4):295–8. [PubMed: 16340497]. 17. Shibayama J, Oku H, Imamura Y, Kajiura S, Sugasawa J, Ikeda T. Bilateral, nearly simultaneous anterior ischemic optic neuropathy complicated by diabetes and bilateral, small, crowded optic discs. Jpn J Ophthalmol. 2005;49(3):235–8. doi: 10.1007/s10384-004-0179-3. [PubMed: 15944831]. 18. Moschos MM, Margetis I. Bilateral simultaneous anterior ischemic optic neuropathy associated with sildenafil. Case Rep Ophthalmol. 2011;2(2):262–5. doi: 10.1159/000331111. [PubMed: 21941503].
    15. Karli SZ, Liao SD, Carey AR, Lam BL, Wester ST. Optic neuropathy associated with the use of over-the-counter sexual enhancement supplements. Clin Ophthalmol. 2014;8:2171–5. doi: 10.2147/OPTH.S73059. [PubMed: 25378904].
    16. Taner P, Ergin A, Basar MM, Batislam E, Bilgili YK. Sildenafil does not alter retrobulbar hemodynamics in postural variations. J Neuroophthalmol. 2009;29(2):59–64. doi: 10.1080/01658100590933433.