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• Viagra and branch retinal artery occlusion: a stiff response
  Published on: 6 September 2000

• Published on: 6 September 2000

  Viagra and branch retinal artery occlusion: a stiff response

  • , Research Fellow
  • Other Contributors:
    • William Westlake

  Editor,
  I was interested to read the case report of branch retinal artery occlusion (BRAO) in a 69 year old male that was presumed to have been caused by sildenafil.

  In addition to transient cardiac arrhythmia, the authors speculate that the underlying mechanism of arterial occlusion may have been a sudden rise in intra-ocular pressure caused by Viagra. They do not mention whether the arteri...

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  Editor,
  I was interested to read the case report of branch retinal artery occlusion (BRAO) in a 69 year old male that was presumed to have been caused by sildenafil.

  In addition to transient cardiac arrhythmia, the authors speculate that the underlying mechanism of arterial occlusion may have been a sudden rise in intra-ocular pressure caused by Viagra. They do not mention whether the arterial occlusion had any relationship to coitus. If the speculation that Viagra did elevate IOP is correct, the physical activity of coitus would tend to reduce intraocular pressure (1) possibly normalising the IOP. On the other hand, sexual arousal has been found to precipitate angle closure glaucoma in anatomically predisposed eyes (2, 3) in which case the elevated IOP, if indeed it was ever present, possibly may not have been caused by Viagra.

  The absence of risk factors in the reported patient should not automatically implicate Viagra as the cause of BRAO, since the underlying aetiology is unclear in a sizeable minority of patients with retinal arterial occlusive disease (4). Coitus has previously been associated with amarosis fugax (5), and Tripathi and O'Donnell acknowledge that many patients using Viagra would be at a high risk of vascular occlusions anyway.

  The authors recommend that branch retinal artery occlusion "should be…discussed with all patients started on sildenafil". It would place an unacceptable burden on both doctors and their patients if they had to discuss every side effect of prescribed drugs, especially if the possible side effect has only ever been reported once in many tens of millions prescriptions. In many instances, even if the time was available for such discussion, this would probably generate unnecessary anxiety and cause further harm to the patient by reducing patient compliance.

  I would avoid alarming patients with speculation that Viagra may cause blindness until more compelling evidence is available to justify this warning.

  1) Harris A, Arend O, Bohnke K, et al. Retinal blood flow during dynamic exercise. Graefes Arch Clin Exp Ophthalmol. 1996;234:440-4.
  2) Friedberg DN, Fox LE. Blurred vision during sexual arousal associated with narrow-angle glaucoma. Am J Ophthalmol 1999;128:647-648.
  3) Markovits A. Ophthalmodynia hypertonica copulationis: a new syndrome? Can J Ophthalmol 1974:9:484-485.
  4) Haase CG, Buchner T. Microemboli are not a prerequisite in retinal artery occlusive diseases. Eye 1998;12:659-662.
  5) Teman A, Winterkorn J, Weiner D. Transient monocular blindness associated with sexual intercourse. N Engl J Med 1995;333:393

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  Conflict of Interest:
  None declared.

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