Anterior Ischemic Optic Neuropathy ( AION )

By posted on July 8, 2014 4:43PM
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 )

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