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 present
Headache, temporal and scalp tenderness
Jaw claudication
Malaise, anorexia, weight loss, fever, joint &
muscle pain
Ear 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
<40 >50 Age
92%+ Unusual pain
APD+ APD+ Pupil
Central Altitudinal VF
Edema 33%
hyperemic
Edema 100%
pale
Optic disk
Unusual Common Retinal
hemorrhage
No delayed Delayed disk
filling
F.A.
enhancement No optic nereve
enhancement
MRI
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
60 yr Mean 70 yr Age
F=M F>M Sex
None Headache Symptoms
>20/200 60% <20/200 60% VA
Small cup
Hyperemic edema
Normal cup pale
edema
Fundus
Mean 20-40mm/hr Mean 70mm/hr ESR
Normal Elevated C.R.P.
31% improved
12-19% fellow eye
Rarely improved
54-95% fellow
eye
Natural history
None proven Systemic steroids treatment
summary