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Purpose: Our goal was to determine whether visual system responses to sildenafil accompany shifts in ocular perfusion. The human choroid, which supports the metabolic function of the outer retina, is an erectile tissue, analogous in many respects to the corpus cavenosum., Methods: Right eyes of 12 normal adults were evaluated before and 2 h after 50 mg oral dose of sildenafil. Pulsatile ocular blood flow (POBF), intraocular pressure (IOP), Heidelberg retinal flowmetry (HRT), 4.26 cpd, 7.5 Hz temporally-modulated contrast sensitivity (CS), full-threshold C-20 frequency doubling technology (FDT) perimetry, and blood pressure (BP) were measured., Results: POBF (+29.4%; p > 0.016) and CS (+33.6%; p > 0.014%) increased within 110 (+/-7.7) minutes after sildenafil administration. No subject demonstrated decreases in either variable. HRF flow values increase among 7 of the 9 eyes producing stable scans (+8.2%; p > 0.1). FDT values did not change significantly, nor did systemic pulse amplitude or mean IOP., Conclusions: Since IOP and systemic pulse amplitude both remained stable after sildenafil administration, while POBF values increased to a level nearly one third greater than baseline. It appears sildenafil can induce intrinsic change in the choroidal vasculature, with an apparently positive impact on pericentral contrast sensitivity. This effect may be of clinical utility.