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Anterior ischemic optic neuropathy (AION). Most common over 50 years Painless monocular over hours to days Visual acuity Visual field APD. AION. Arteritic AION is associated with giant cell arteries (GCA) Nonarteritic AION. AAION. Is less frequent 5-10% Older patients (mean 70yr) - PowerPoint PPT Presentation
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Anterior ischemic optic neuropathy (AION)
Most common over 50 years Painless monocular over hours to days Visual acuity Visual field APD
AION
Arteritic AION is associated with giant cell arteries (GCA)
Nonarteritic AION
AAION
Is less frequent 5-10% Older patients (mean 70yr) Inflammatory and thrombotic occlusion
post. Cilliary artery Systemic symptoms
Systemic Findings of GCA
Are usually presentHeadache, temporal and scalp tendernessJaw claudicationMalaise, anorexia, weight loss, fever, joint &
muscle painEar pain
AAION
Sever visual loss Pale edema Cotton wool spot F.A. delayed choroidal filling Normal cup.
Treating AAION
Immediate therapy is critical Temporal artery biopsy may delayed treat IV prednisolone 1 g/day for 3-5 days Then oral prednisolone 100 mg/day
tapered 3-12 month or more
Major Goals of Therapy
Prevent contralateral visual loss Fellow eye involved 95% days or weeks Affected eye improve somewhat Avoid systemic vascular complication Risk of recurrence is 7% so tapering must
be slow and careful
Nonarteritic Anterior ISchemic Optic Neuropathy (NAION)
More common 90-95% of AION In younger age groups (mean age 60yr) Related to optic disc microcirculation On awakening, noctural systemic
Hypotension Systemic symptoms are absent
NAION
V.A. > 20/200 in over 60% of cases Palor is less common Optic disk in other eye is small and small
or absent cup. 5 yr risk of other eye is 14.7% (psued-
foster kennedy syd)
Risk Factors of NAION
Crowding of disk (disk at risk) Systemic hypertension Diabetes (young) Smoking, hyperlipidemia Hyperhomocysteinemia, platelet
polymorphism, sleep apnea Phosphodiestrase inhibitors (sildenafil or
viagra) ?? Hypotensive effect
Differential Diagnosis of NAION
Optic neuritis Infiltrative optic neuropathies Anterior orbital lesion Diabetic papillopathy
Age>50<40
painUnusual92%+
PupilAPD+APD+
VFAltitudinalCentral
Optic diskEdema 100% pale
Edema 33% hyperemic
Retinal hemorrhage
CommonUnusual
F.A.Delayed disk filling
No delayed
MRINo optic nereve enhancement
enhancement
NAION Optic neurtis
Treatment of NAION
Untreated case remain stable but recovery of 3 lines 31% after 2 years
Recurrence unusual 6.4% No proven therapy surgery no benefit No proven prophylaxis Asprin reducing incidence of fellow eye is
unclear
AgeMean 70 yr60 yr
SexF>MF=M
SymptomsHeadache …None
VA<20/200 60%>20/200 60%
FundusNormal cup pale edema
Small cup
Hyperemic edema
ESRMean 70mm/hrMean 20-40mm/hr
C.R.P.ElevatedNormal
Natural historyRarely improved 54-95% fellow eye
31% improved
12-19% fellow eye
treatmentSystemic steroidsNone proven
summary
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