Ischemic Optic Neuritis

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

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II. 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

III. 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)

IV. Epidemiology

  1. See Giant Cell Arteritis
  2. Onset after age 40 years in those with Cardiac Risk Factors (see below)

V. Risk Factors: Non-arteritic Ischemic Optic neuropathy (arteriolar sclerosis)

  1. Diabetes Mellitus
  2. Hypertension
  3. Hyperlipidemia
  4. Tobacco Abuse

VI. 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

VII. Signs

  1. Central vessel changes
  2. Optic disc edema
  3. Ischemic Iritis
  4. Large blind spot

VIII. 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

IX. References

  1. Trobe (2012) Physician Guide to Eye Care, p. 141-3

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