Table 2.
Summary of case reports/series on sildenafil-induced visual side effects published on the last decade (2010–2020).
| Reference | Subject(s) | Dose | Risk Factors | Diagnosis |
|---|---|---|---|---|
| Felekis et al., 2011 [32] PMID 22034568 |
Man, age 51 | Unknown, once a week for the last 6 months | Mild hypercholesterolemia Family history of NAION | Unilateral NAION (RE): decreased visual acuity, visual field loss, relative afferent pupillary defect, altered color perception, and optic disk edema |
| Moschos and Margetis, 2011 [33] PMID 21941503 |
Man, age 55 | 50 mg, 4–5 times a month for the last 8 months | None | Bilateral NAION: decreased visual acuity, visual field loss, relative afferent pupillary defect, and optic disk edema |
| Izadi et al., 2012 [43] PMID 22928790 |
Man, age 48 | 1500 mg, over a 4-hour period | None | Bilateral central visual field ring scotomas and reduced PERG amplitude |
| Tarantini et al., 2012 [44] PMID 22481954 |
Man, age 60 | 50 mg, 3 consecutive days | Noninsulin-dependent diabetes for the last 7 months, treated with metformin | Bilateral NAION: decreased visual acuity, visual field loss, optic disc edema, peripapillary nerve fiber layer hemorrhages, and serous macular detachment (only in RE) |
| Gaffuri et al., 2014 [45] PMID 24895393 |
Woman, 7-month-old infant | 0.6 mg/kg/day in three doses | Preterm birth for maternal preeclampsia (34 weeks of gestation) | Bilateral NAION: sudden onset of visual loss with optic disc pallor, poor pupillary light reflex, arterial venous tortuous vessels, peripapillary retinal hemorrhages, and macular exudation |
| Congenital heart defect | ||||
| Karli et al., 2014 [46] PMID 25378904 |
Man, age 42 | Unknown | None | Unilateral atypical optic neuropathy (RE): vision loss, pain with ocular motility, optic disk edema, and optic nerve enhancement on MRI consistent with optic neuritis |
| Matheeussen et al., 2015 [47] PMID 26139313 |
Man, age 56 | Overdose, 65 × 100 mg | None | Blurred vision and difficulties in distinguishing facial expressions. Subjective visual perception included a dark view with occasional light flashes |
| Coca et al., 2016 [48] PMID 27316292 |
Woman, age 39 | 3 × 20 mg a day, for the last 3 years | Bronchopulmonary dysplasia secondary to prematurity, PAH, kyphoscoliosis, pectus defect status postsurgery as an infant, severe obstructive and restrictive lung disease | Bilateral acute retrobulbar optic neuropathy attributable to PION |
| Jayadev et al., 2016 [49] PMID 27915325 |
Woman, premature infant (24.5 weeks of gestation) | 0.8 mg/kg/day in 3 doses, starting on the 33rd week | Aggressive posterior retinopathy of prematurity and PAH | Bilateral retinal neovascularization in the eyes’ temporal quadrants, with hemorrhage in the LE |
| Sajjad and Weng, 2016 [50] PMID 27355186 |
Woman, age 32 | 3 × 20 mg a day, for the last 5 years | PAH and migraines | Bilateral asymmetrical outer macular atrophy: RPE mottling and atrophy in the RE, parafoveal RPE mottling and atrophy in a ring-like configuration, with decreased visual acuity in the LE |
| Family history of PAH | ||||
| Medications: topiramate, norethindrone, ambrisentan, tramadol, furosemide, pironolactone, and digoxin | ||||
| Li et al., 2018 [34] PMID 29487830 |
Woman, age 32 | Overdose, 2000 mg | None | Color vision defects and blurred vision that resolved 38 days after drug uptake |
| Neufeld & Warner, 2018 [42] PMID 29215388 |
Man, age 66 | Unknown, history of sildenafil use for 7 years, symptoms appear after using a “double dose” | Hypertension and hypercholesterolemia | Bilateral sequential NAION: visual field loss, relative afferent pupillary defect, and optic disk edema in the LE, with progressive visual acuity deterioration. One year later, the patient developed similar visual defects in the RE after using sildenafil 2 days in a row |
| Papageorgiou et al., 2018 [35] PMID 29374976 |
Man, age 56 | Overdose, 40 × 100 mg | None | Retinal toxicity: decreased visual acuity, mild dilation of the retinal vessels, increased choroidal thickness, and persistent central ring scotomas on both eyes |
| Rickmann et al., 2018 [36] PMID 28776160 |
Man, age 53 | 50 mg, single dose | None | Acute unilateral loss of vision (RE) |
| Rosen et al., 2018 [37] PMID 30286227 |
Man, 57 | 100 mg, single dose | None | Photophobia and transient red-green deficiency. Colour perception improved 7 days after discontinuing sildenafil |
| Yanoga et al., 2018 [38] PMID 29489563 |
Man, age 31 | Unknown (>50 mg/mL), single dose | None | Multicolor photopsias, erythropsia, subjective sense of decreased contrast, increased choroidal thickness, and outer retina disruptions |
| Brader et al., 2019 [39] PMID 30629106 |
Man, age not specified (mid 50s) | 750 mg, single dose | None | Photophobia, nyctalopia, bilateral central ring-shaped scotomas, and outer retina disruptions |
| Mohammadpour et al., 2019 [40] PMID 31372081 |
Man, age 35 | 4 × 100 mg in a three-day period | None | Unilateral central serous chorioretinopathy (LE): decreased vision, metamorphopsia, altered colour perception, loss of foveal reflex, serous retinal detachment in the foveal region, and increased foveal thickness |
| Karaarslan, 2020 [41] PMID 32117027 |
17 men, age 38–57 | 100 mg, single dose | None of the 17 patients had a history of ocular pathology (including glaucoma) or any diagnosed systemic disease | 52.9% exhibited some degree of clinical photophobia, 76.5% had altered colour vision, 17.6% had a deficiency in stereopsis, 35.3% had a transient contrast sensitivity impairment, and 47.1% had abnormally dilated pupils although no relative afferent defects were found |
NAION: nonarteritic anterior ischemic optic neuropathy; RE: right eye; LE: left eye; PERG: pattern electroretinogram; PION: posterior ischemic optic neuropathy; RPE: retinal pigment epithelium; PAH: pulmonary arterial hypertension.