Pupil-sparing third nerve palsy associated with sildenafil citrate (Viagra)

Am J Ophthalmol. 1998 Sep;126(3):476-7. doi: 10.1016/s0002-9394(98)00243-8.


Purpose: To report unilateral pupil-sparing third nerve palsy after use of sildenafil citrate (Viagra).

Method: Case report.

Results: A 56-year-old man with a history of tobacco abuse was treated for erectile dysfunction. Viagra, 50 mg, was taken once without adverse effect. Three weeks later, the patient took a second dose of Viagra (50 mg); 36 hours later he experienced a complete pupil-sparing third nerve palsy. Erythrocyte sedimentation rate, blood glucose level, magnetic resonance imaging, and magnetic resonance angiography were normal.

Conclusion: In a patient with microvascular disease, use of sildenafil may be associated with pupil-sparing third nerve palsy.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Glucose / analysis
  • Blood Sedimentation
  • Enzyme Inhibitors / adverse effects*
  • Humans
  • Iris / innervation*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Oculomotor Nerve Diseases / chemically induced*
  • Piperazines / adverse effects*
  • Pupil
  • Purines
  • Sildenafil Citrate
  • Sulfones


  • Blood Glucose
  • Enzyme Inhibitors
  • Piperazines
  • Purines
  • Sulfones
  • Sildenafil Citrate