Neuro

Ischemic Optic Neuritis

search

Ischemic Optic Neuritis, Ischemic Optic Neuropathy, Anterior Ischemic Optic Neuropathy, Non-arteritic Ischemic Optic neuropathy, Optic Arteriolar Sclerosis

  • See Also
  1. Optic Neuritis
  2. Giant Cell Arteritis (Arteritic Ischemic Optic Neuropathy)
  • Pathophysiology
  • Non-arteritic Ischemic Optic neuropathy
  1. See Giant Cell Arteritis or Temporal Arteritis for Arteritic Ischemic Optic Neuropathy
  2. Arteriolar sclerosis causing gradual Occlusion of posterior ciliary arteries
  • Types
  1. Arteritic Ischemic Optic Neuropathy
    1. See Giant Cell Arteritis (Temporal Arteritis)
  2. Non-arteritic Ischemic Optic neuropathy
    1. Arteriolar sclerosis (see risk factors below)
  • Epidemiology
  1. See Giant Cell Arteritis
  2. Onset after age 40 years in those with Cardiac Risk Factors (see below)
  • Risk Factors
  • Non-arteritic Ischemic Optic neuropathy (arteriolar sclerosis)
  1. Diabetes Mellitus
  2. Hypertension
  3. Hyperlipidemia
  4. Tobacco Abuse
  • Symptoms
  1. Acute painless, irreversible Vision Loss
  2. Non-arteritic Ischemic Optic neuropathy
    1. No systemic symptoms
  3. Arteritic Ischemic Optic Neuropathy
    1. See Giant Cell Arteritis
  • Signs
  1. Central vessel changes
  2. Optic disc edema
  3. Ischemic Iritis
  4. Large blind spot
  • Management
  1. Urgent Ophthalmology referral
  2. Arteritic Ischemic Optic Neuropathy
    1. See Giant Cell Arteritis
    2. High dose Corticosteroids immediately (do not wait for temporal artery biopsy)
      1. Prednisone 2 mg/kg/day or Methylprednisolone 250 mg every 6 hours IV
      2. Goal is to preserve other, healthy eye
  3. Non-arteritic Ischemic Optic neuropathy
    1. Corticosteroids are also indicated immediately
      1. Discuss with ophthalology
    2. Cardiovascular Risk Factor modification
  • References
  1. Trobe (2012) Physician Guide to Eye Care, p. 141-3