Sequential, non-arteritic anterior ischemic optic neuropathy in patients taking sildenafil: a report of ten cases

Aim/purpose: To present a summary of 10 cases of non-arteritic anterior ischemic optic neuropathy (NAION) in patients who received phosphodiesterase type 5 (PDE-5) inhibitors. Methods: A case series of 10 patients who, after regular intake of Sildenafil, presented with a first episode of NAION in one eye. NAION was diagnosed based on the following criteria: acute, painless, unilateral loss of vision, fundus features consistent with NAION and exclusion of other possible causes. Results: Despite the initial adverse event (first episode of NAION), all of these patients continued to use the medication and developed a second episode of NAION in the contralateral eye. Only one of the 10 patients presented with bilateral simultaneous NAION. Conclusion: This largest case series published to date, reinforces the general consensus that PDE-5 inhibitors are contraindicatedin patients with a history of unilateral NAION.