Breaking News
You are here: Home » Ophthalmology Atlas » Retina Atlas » Anterior Ischemic Optic Neuropathy ( AION )
Anterior Ischemic Optic Neuropathy ( AION )

Anterior Ischemic Optic Neuropathy ( AION )

Anterior Ischemic Optic Neuropathy ( AION )

Infarction of optic nerve head just posterior to lamina
cribrosa due to inadequate perfusion by posterior ciliary
arteries; results in acute visual loss.
2 forms: arteritic (giant cell arteritis); nonarteritic
(ischemic).

Findings:decreased color vision and acuity, positive
RAPD, VF loss (altitudinal or arcuate defects most common,
central scotomas also occur), unilateral optic disc edema
(often involving 1 sector), contralateral disc appears
crowded (small C/D ratio).

Arteritic :due to giant cell (temporal) arteritis
(inflammatory vasculopathy affecting medium-sized to large
vessels) affecting the posterior ciliary arteries; female > male
(2:1); aged >55 years; may have amaurosis fugax or
diplopia

Other findings: scalp tenderness, jaw or tongue
claudication, polymyalgia rheumatica (PMR), fever,
malaise, anorexia, weight loss, anemia, headache,
tender temporal artery, neck pain, brain stem stroke
(due to involvement of vertebral artery); cotton wool
spots, choroidal ischemia (seen as patchy choroidal
filling on fluorescein angiography (FA))

Diagnosis: elevated ESR (for men > [age/2]; for women
> [(age +10)/2]; may be normal in 10%), C-reactive
protein (above 2.45╯mg/dL), low hematocrit (anemia
of chronic illness), FA (patchy choroidal filling,
nonperfusion), temporal artery biopsy (inflammation
in artery wall with disruption of internal elastica
lamina, skip lesions [specimen at least 3cm], perform
within 2 weeks of steroid treatment).

Treatment (emergent): steroids (prednisone 60–120mg
orally; consider IV initially [1g for 3 days]) to prevent
fellow eye involvement (65% risk of involvement of
fellow eye without treatment; usually affected within
10 days); some patients lose vision despite treatment

Nonarteritic (NAION) (ischemic): no associated
symptoms; usually aged 50–75 years; associated with
microvascular disease (diabetes, hypertension) and collagen
vascular disorders; recurrence in same eye is rare; 25–40%
risk of fellow eye involvement; normal ESR; NAION may be
mimicked by amiodarone and phosphodiesterase-5
inhibitors.

Treatment: none

ISCHEMIC OPTIC NEUROPATHY DECOMPRESSION
TRIAL (IONDT): optic nerve sheath fenestration is
not effective
Smokers had earlier mean onset (age 64) than
nonsmokers (age 70)
43% of control patients regained 3 or more lines of
vision at 6 months (vs 34% of those having surgery)
Surgery had higher risk of loss of 3 lines of vision
(24% vs 12% with observation)

Pseudo Foster-Kennedy syndrome: AION is the most
frequent cause of unilateral disc edema and contralateral
optic atrophy; disc not hyperemic like true Foster-Kennedy
syndrome.

Anterior Ischemic Optic Neuropathy ( AION )

Anterior Ischemic Optic Neuropathy ( AION )

Source: 

Ophthalmology Atlas(Photos of cases)

Anterior Ischemic Optic Neuropathy ( AION )

Comments

comments

Anterior Ischemic Optic Neuropathy ( AION ) Infarction of optic nerve head just posterior to lamina cribrosa due to inadequate perfusion by posterior ciliary arteries; results in acute visual loss. 2 forms: arteritic (giant cell arteritis); nonarteritic (ischemic). Findings:decreased color vision and acuity, positive RAPD, VF loss (altitudinal or arcuate defects most common, central scotomas …

Review Overview

0

About Ophthalmology Notes

Ophthalmology Notes
We do our best to simplify ophthalmology in Short Notes and exchange practical experiences between ophthalmologists all over the world.

One comment

  1. megapolis hack gratis

    Helpful Topic

Leave a Reply

Your email address will not be published. Required fields are marked *

*

Google+
Scroll To Top
Skip to toolbar