Pathophysiology of visual disorders induced by phosphodiesterase inhibitors in the treatment of erectile dysfunction

Abstract

AimThe aim of this review was to summarize the ocular action of the most common phosphodiesterase (PDE) inhibitors used for the treatment of erectile dysfunction and the subsequent visual disorders.MethodThis is a literature review of several important articles focusing on the pathophysiology of visual disorders induced by PDE inhibitors.ResultsPDE inhibitors have been associated with ocular side effects, including changes in color vision and light perception, blurred vision, transient alterations in electroretinogram (ERG), conjunctival hyperemia, ocular pain, and photophobia. Sildenafil and tadalafil may induce reversible increase in intraocular pressure and be involved in the development of non-arteritic ischemic optic neuropathy. Reversible idiopathic serous macular detachment, central serous chorioretinopathy, and ERG disturbances have been related to the significant impact of sildenafil and tadalafil on retinal perfusion.DiscussionSo far, PDE inhibitors do not seem to cause permanent toxic effects on chorioretinal tissue and photoreceptors. However, physicians should write down any visual symptom observed during PDE treatment and refer the patients to ophthalmologists.

Kiwifruit extract attenuates tadalafil induced retinal injury in adult male albino rats: a histological and immunohistochemical study

“…This elevated intraocular pressure might cause retinal ganglion cells apoptosis [50,51] . It was reported that PDE-5 enzyme inhibitors cause dilatation of the choroidal fenestrated capillaries and leakage of plasma rich fluid into the anterior chamber with subsequent increase in the intraocular pressure [52,53,54] . In addition, the increased intraocular pressure as well as the changes in ocular blood flow diminishes the power of retinal pigment epithelium to pump fluid from retina to choroid [55] , and this negatively affect the retinal metabolism and might contribute to the pathogenesis of retinal pigment epithelium detachment, outer limiting membrane disruption and wide separation of photoreceptors outer segments that were observed in tadalafil group of this study.…”

Ocular Side Effects of Sildenafil That Persist Beyond 24 h—A Case Series

“…In a study of 15 patients using 50 mg sildenafil twice weekly for 3 months, no significant effects on best-corrected visual acuity or introaocular pressure were observed (4,5). Acute secondary effects of sildenafil include headache, heartburn, skin flush, and vision changes such as blurred vision, photophobia, and cyanopsia [i.e., blue-tinted vision; (6)]. Here, we report a case series of patients who experienced visual disturbances that persisted for more than 24 h in response to taking sildenafil.…”

Striking Funduscopic Findings in a Patient after Drug-Supported Sexual Activity

“…The most experimental studies with sildenafil described a venous dilatation and an increased flow, contrary to the study of Grunwald et al, which reported no effect on retinal circulation [4 -6]. Eltony et al postulated a toxic effect of chronic treatment with sildenafil in adult male rats, whereas Moschos reported no permanent toxic effects on chorioretinal tissue in humans after sildenafil intake [7,8]. Ophthalmic adverse drug re- A preretinal hemorrhage is usually induced by Valsalva retinopathy.…”