PURPOSE: To describe the known ocular side effects of agents used to treat erectile dysfunction. DESIGN: Retrospective observational case series and literature review. METHODS: We reviewed 892 case reports from the National Registry of Drug-Induced Ocular Side Effects (Casey Eye Institute, Portland, Oregon), the Food and Drug Administration (FDA), and the World Health Organization (WHO) and conducted a comprehensive review of the literature. RESULTS: Ocular side effects of these drugs appear fully reversible and transitory. CONCLUSIONS: To date, evidence does not exist to discourage use of erectile dysfunction agents attributable to harmful ocular side effects. Ischemic optic neuropathy (ION) is "possible" by WHO classification, however, conclusive evidence linking ION to erectile dysfunction medications is still lacking.