Cialis Use with History of Traumatic Retinal Tear
Cialis (tadalafil) can be used with a history of traumatic retinal tear that has been successfully treated and is stable, but requires ophthalmologic clearance to ensure the tear has been adequately repaired and there is no active retinal pathology or risk of progression.
Key Safety Considerations
Retinal Tear Status Assessment Required
The critical factor is whether the traumatic retinal tear has been treated and is stable 1. If the tear was successfully treated with laser photocoagulation or cryotherapy and has formed a stable chorioretinal adhesion, the risk of progression to retinal detachment is reduced to less than 5% 1, 2.
Active or untreated retinal tears represent a contraindication until properly managed 1. Symptomatic retinal breaks with persistent vitreoretinal traction have at least a 50% risk of progressing to clinical retinal detachment if left untreated 3, 2.
Tadalafil's Retinal Safety Profile
Tadalafil has minimal activity against PDE6 (the phosphodiesterase isoform found in retinal photoreceptors), making it less likely to cause visual side effects compared to other PDE5 inhibitors 4.
No visual side effects were noted in clinical studies of tadalafil at therapeutic doses 4, and it appears to have a relatively mild side-effect profile regarding ocular complications.
Rare case reports exist of reversible photoreceptor damage with tadalafil use, manifesting as hyperreflective changes on OCT that resolved with drug discontinuation 5. However, these effects were temporary and did not involve structural retinal tears or detachment.
Clinical Algorithm for Decision-Making
Step 1: Ophthalmologic Evaluation
Step 2: Risk Stratification
Low Risk (Cialis can be used):
- Traumatic tear was treated with laser or cryotherapy 1, 2
- Stable chorioretinal scar present on examination 2
- No new symptoms (floaters, flashes, visual field defects) 3
- No evidence of active vitreoretinal traction 1
High Risk (Defer Cialis until cleared):
- Untreated retinal tear or dialysis 1, 3
- Recent trauma (within weeks to months) 1
- Presence of vitreous hemorrhage or pigmented cells 1, 3
- Subclinical retinal detachment present 1
- Fellow eye has history of retinal detachment (10% increased risk in second eye) 1
Step 3: Patient Education
Instruct patient to immediately report new visual symptoms including increased floaters, flashes of light, visual field defects, or decreased visual acuity 3, 2, as these may indicate new retinal pathology unrelated to tadalafil use.
Emphasize that tadalafil itself does not cause structural retinal tears 5, 6, 4, but any medication use should be discussed with their ophthalmologist if new visual symptoms develop.
Important Caveats
Traumatic Retinal Pathology Considerations
Trauma-induced vitreoretinal changes may be detected years after the initial injury 1, so even remote traumatic tears require current ophthalmologic assessment before initiating tadalafil.
Blunt or penetrating ocular injuries that altered vitreous or retinal structure increase ongoing risk of retinal detachment 1, independent of medication use.
PDE5 Inhibitor Class Effects
While tadalafil has minimal PDE6 activity 4, all PDE5 inhibitors can cause transient changes in retinal perfusion 6. However, these hemodynamic effects have not been shown to cause or worsen retinal tears at therapeutic doses.
Recreational or supratherapeutic doses carry higher risk of visual side effects 6, though still primarily involving reversible changes rather than structural damage.
Monitoring Requirements
Regular ophthalmologic follow-up remains necessary 3, 2 for anyone with history of traumatic retinal tear, regardless of tadalafil use, as 5-14% develop new breaks over time 1, 2.
Both eyes should be evaluated 3, as pathologic vitreoretinal changes can occur bilaterally even if trauma appeared unilateral.