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Nonarteritic Ischemic Optic Neuropathy (NAION) in Patient on Phosphodiesterase Inhibitor

Purpose: To identify nonarteritic ischemic optic neuropathy (NAION) in a patient taking a phosphodiesterase (PDE) inhibitor.

Description

A patient who takes a phosphodiesterase (PDE) inhibitor may develop nonarteritic ischemic optic neuropathy (NAION). It is uncertain if the PDE inhibitor is the cause of the NAION or just being taken coincidentally in a patient with poor ocular perfusion. Fortunately this is a rare condition.


 

PDE inhibitors include:

(1) sildenafil (Viagra)

(2) tadalafil (Cialis)

(3) vardenafil (Levitra)

 

Patients taking PDE inhibitors may include:

(1) man with erectile dysfunction

(2) pulmonary arterial hypertension

(3) altitude sickness

(4) COPD or asthma

 

Clinical findings:

(1) There may be blurring of vision in one or both eyes.

(2) There may be a loss of visual field in one or both eyes.

(3) The change in vision may occur soon after a dose or the next day. It may develop in a novice user or a person using the drugs for some time.

(4) The change in vision may be progressive.

(5) The change in vision is usually permanent.

 

Risk factors:

(1) age > 50 years

(2) risk factors for atherosclerosis (smoking, hypertension, hyperlipidemia, diabetes)

(3) small optic cup to disc ratio

(4) continued use of the drug after onset of visual symptom

 


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Specialty

Objective

ICD-10