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