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A putative increase in choroidal volume could have contributed to the IOP elevation Kiel, 1994. It does indeed appear that sildenafil increases choroidal blood flow Harris et al.

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Such flow could result in a higher leak of plasma-like fluid from the fenestrated capillaries of the ciliary body, and subsequent leakage of such fluid directly into the anterior chamber across the front face of the iris, given the absence of an anatomical barrier at this surface Bill, 1975; Freddo,.

Consistent with this possibility, we measured higher levels of protein in the anterior chamber of sheep following sildenafil ingestion Gerometta et al.

It is also possible that ingestion of PDE 5 inhibitors could increase the cGMP levels of anterior-segment ocular tissues involved in aqueous humor dynamics. There are reports that cGMP inhibits transport in the isolated porcine ciliary body Fleischhauer et al.

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However, such reduction in fluid transport and increased outflow facility would have an effect on IOP opposite to the one that we observed. Thus, these possible effects seem to have been overwhelmed by the effect of sildenafil on ocular vascular flow, as judged by the increased protein content of the anterior chamber in the sheep animal model upon sildenafil ingestion Gerometta et al.

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