Sildenafil-Associated Anterior Ischemic Optic Neuropathy with Optic Nerve Enhancement in Brain Magnetic Resonance Imaging and Pleocytosis in Cerebrospinal Fluid: A Case Report.

Introduction: Anterior ischemic optic neuropathy (AION) is characterized by an acute, painless decrease in visual acuity due to restricted blood flow to the optic nerve. It is categorized into two types: arteritic AION and non-arteritic AION, which is more prevalent and is also associated with the use of sildenafil. Case Presentation: The patient was a 64-year-old male who presented with sudden, painless, blurred vision in both eyes, progressing to near blindness with minimal light perception. The patient had taken sildenafil the night before symptom onset. A thorough workup, including history-taking, laboratory tests, and imaging, revealed no alternative etiology for the vision loss other than sildenafil use. Nevertheless, he presented atypical features, such as optic nerve enhancement in brain contrast-enhanced magnetic resonance imaging and pleocytosis in cerebrospinal fluid, which are uncommon in sildenafil-associated AION cases. Conclusion: This case contributes to the growing literature on sildenafil-associated AION, underscoring the importance of raising awareness about this potential side effect. These findings highlight the importance of appropriate management and evaluation of patients with sudden visual loss. The improvement in symptoms with corticosteroid therapy in the acute phase suggests that some patients may benefit from early intervention.