sildenafil-citrate and Blindness

We report a case of posterior non-arteritic ischaemic optic neuropathy (NAION) causing bilateral visual loss in a 7-month-old female infant, after a therapeutic course with sildenafil, a phosphodiesterase type 5 inhibitors (PDE5i). The patient was affected by a complex cyanotic congenital heart defect and had undergone cavopulmonary anastomosis (Glenn operation) 3 months ago. After 2 months of recurring chylothorax, a course of oral sildenafil was administered, with the hypothesis that pulmonary vascular resistances were increased. Approximately 4 weeks later the acute onset of visual worsening and poor pupillary light reflex prompted the diagnosis of posterior NAION. Despite a rapid cessation of PDE5i and systemic treatment with corticosteroids, no visual recovery was noticed at 2-year follow-up. NAION has been associated with PDE5i therapy in adults, but to the best of our knowledge it is almost unheard of in children. We suggest close monitoring of visual function in children undergoing treatment with sildenafil.

Topics: Acute Disease; Blindness; Diagnosis, Differential; Female; Follow-Up Studies; Heart Defects, Congenital; Humans; Infant; Magnetic Resonance Imaging; Optic Neuropathy, Ischemic; Phosphodiesterase 5 Inhibitors; Piperazines; Purines; Sildenafil Citrate; Sulfones; Tomography, X-Ray Computed; Visual Acuity

Since the launch in 1998 of the anti-impotence drug sildenafil (viagra), the American food and drug administration has identified 50 cases of drug-related blindness, the so-called nonarteritic anterior ischemic optic neuropathy. This, very serious, side effect frequently leads to sudden, mostly irreversible loss of vision, and there is no proven effective treatment to cure patients or to prevent recurrence. The mechanism of ischemic optic neuropathy is not clear, but it could be related to the fact that the ophthalmic and central retinal arteries have an autoregulation of their own blood flow without any autonomic nerve supply; vasoreactivity could be lower albeit efficient, and therefore more vulnerable to systemic modifications of the circulation. But decreased visual acuity and loss of visual ability also are, although uncommon, anesthesiological and surgical complications. These data are consistent with the hypothesis that sildenafil, surgery and anesthesia, taken together, could be a potentially dangerous cocktail of risk factors for sudden irreversible loss of vision. To reduce the risk, sildenafil use should be avoided at least one week before surgical operations, since the reported cases of blindness developed 36h after drug ingestion.

Topics: Anesthesia; Blindness; Carbon Dioxide; Humans; Hypertension; Ischemia; Male; Optic Nerve; Optic Nerve Diseases; Optic Neuropathy, Ischemic; Piperazines; Postoperative Complications; Purines; Risk; Risk Factors; Sildenafil Citrate; Sulfones; Vasodilator Agents

Topics: Aged; Blindness; Humans; Macular Edema; Male; Piperazines; Purines; Sildenafil Citrate; Sulfones; Vasodilator Agents

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Blindness; Humans; Male; Optic Neuropathy, Ischemic; Phosphodiesterase Inhibitors; Piperazines; Purines; Sildenafil Citrate; Sulfones

We report on a case of combined nonarteritic anterior ischemic optic neuropathy (NAAION) and cilioretinal artery occlusion resulting from misuse of sildenafil citrate (Viagra Pfizer Pharmaceuticals, New York, NY).. This is an observational case report.. A 54-year-old white man developed blindness in his left eye after an overdose of Viagra. He was examined and fully evaluated.. Ocular examinations revealed a left relative afferent pupillary defect and a left combined NAAION and obstruction of the ipsilateral cilioretinal artery.. Although ocular side-effects of Viagra are rare, they are potentially blinding. Patients should be warned about the side-effects and against misuse of this agent.

Topics: Blindness; Drug Overdose; Humans; Male; Middle Aged; Optic Neuropathy, Ischemic; Piperazines; Purines; Retinal Artery Occlusion; Sildenafil Citrate; Sulfones

Topics: Blindness; Carbolines; Drug Prescriptions; Drug-Related Side Effects and Adverse Reactions; Erectile Dysfunction; Humans; Imidazoles; Incidence; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Risk Assessment; Risk Factors; Sildenafil Citrate; Sulfones; Tadalafil; Triazines; United States; Vardenafil Dihydrochloride; Vasodilator Agents; Video Recording