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Ischemic Optic Neuropathies

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Optic Nerve Disorders

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Abstract

Ischemic optic neuropathy (ION) is the most common optic nerve disorder in patients over age 50 years. ION is classified as anterior (affecting the optic disc) versus posterior (retrobulbar) and as arteritic versus nonarteritic. Anterior involvement is common with both arteritic and nonarteritic ION.

Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common form of ION, involving painless, acute monocular visual loss initially with blurred central vision, a visual field defect, or both. Most patients stabilize in 1–2 weeks. On examination, patients often present with decreased visual acuity, dyschromatopsia, a relative afferent pupillary defect, and optic disc edema. The unaffected eye often has a small optic cup.

No proven treatments are available for NAION at this time.

Anterior ischemic optic neuropathies (AION) can also be seen in a variety of clinical settings. Diabetic papillopathy is an atypical form of NAION. NAION can be associated with optic disc drusen, Chlamydia pneumonia, acute and chronic anemia, acute hypotension, coagulopathies, migraine, and sleep apnea syndrome.

The most common vasculitic disorder that causes AION is giant cell arteritis (GCA).

Arteritic AION affects older adults, usually over the age of 70 years. It is associated with polymyalgia rheumatica. Transient prodromal visual loss is more common in GCA than in NAION. Disc edema tends to be pallid rather than hyperemic, as in NAION. Conventional treatment is corticosteroids.

Posterior ischemic optic neuropathy (PION) results from infarction of the retrobulbar optic nerve and is distinguished clinically from AION by a normal-appearing optic nerve head. Most patients present with abrupt, painless, unilateral or bilateral loss. There are three distinct etiologic categories that account for the majority of patients with PION: perioperative, such as in the setting of spinal surgeries and radical neck dissection; arteritic, and nonarteritic. PION is a diagnosis of exclusion. Patients with PION and GCA are treated with corticosteroids. There is no proven treatment for perioperative or nonarteritic PION.

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  1. Department of Neurology, Neuro-Ophthalmology, University of Nevada School of Medicine, 975 Kirman Avenue (111), Reno, Nevada, 89502, USA

    Jane W. Chan M.D.

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    Jane W. Chan

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Chan, J.W. (2014). Ischemic Optic Neuropathies. In: Chan, J. (eds) Optic Nerve Disorders. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-0691-4_2

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