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Answer 5
  1. Discontinue sildenafil and all other PDE-5 inhibitors immediately and refer to an ophthalmologist. In contrast to the previous case, this patient may have nonarteritic anterior ischemic optic neuropathy (NAION). NAION is thought to result from decreased blood flow through small arteries supplying the optic nerve. The visual field deficits may be temporary or permanent. Despite controversy over the association of NAION and the use of PDE-5 inhibitors, the temporal association between use of the medication and clinical symptoms should raise significant concern. The patient should be strongly advised to discontinue the PDE-5 inhibitor and should be referred for urgent ophthalmologic evaluation.

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