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Anterior ischemic optic neuropathy (Pathophysiology (Disrupted blood…
Anterior ischemic
optic neuropathy
Definition
Occlusion of short posterior ciliary arteries
that supply the head of the optic nerve
OPHTHALMIC EMERGENCY
Epidemiology
Elderly
Commonest cause of optic neuropathy in older patients
Pathophysiology
Disrupted blood supply to part of the optic nerve,
causing death of nerve fibres and loss of vision
Some cases ischemia of the disc causes
angiogenic proliferation of new vessels on the disc
(NVD) e.g. proliferative DM neuropathy
Often leaky and haemorrhagic
Inflammation or atheroma (arteritic or non-arteritic)
Aetiology
Autoimmune
GCA
Metabolic
Hyperlipidemia
DM
Vascular
Atherosclerosis
HTN
Clinical
presentation
Painless, sudden
loss of vision
Diagnosis
Examination
CN examination
Gross reduction in acuity, RAPD
Fundoscopy
Plae, swollen disc (segmental or complete),
segmental haemorrages (if GCA), NVD
Investigations
Bloods
FBC, CRP/ESR (GCA), U+Es,
glucose (DM), lipids (hyperlipidemia)
Biopsy
Superficial temporal artery (GCA)
Bedisde
Obs (may have fever if GCA, HTN)
Special tests
Perimetry: altitudional visual field defect
History
DH
Current meds, allergies
FH
CVD/sttroke, GCA
PMH
TIA/stroke, GCA,
other CVD
SH
Occupation, driving,
smoking, alcohol
PC/HPC
Sudden painless loss of vision,
headache, jaw claudication,
previous transient loss
Management
Medical
Steroids
Indication: ASAP if ?GCA
E.g. high dose prednisolone IV
MOA: reduces inflammation and
further ischemia
Conservative
Information, advice, support
ASAP to ophthalmology
Identify and treat cause
Lifestyle (smoking, diet, alcohol, weight)
Complications
Blindness
Optic atrophy
Other eye involvement
(if GCA)
