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)

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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Related Studies

Ontology: Optic Neuropathy, Ischemic (C0155305)

Definition (MSHCZE) Onemocnění s ischemií přední části papily zrakového nervu způsobené okluzí ciliárních tepen. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (MSH) Ischemic injury to the OPTIC NERVE which usually affects the OPTIC DISK (optic neuropathy, anterior ischemic) and less frequently the retrobulbar portion of the nerve (optic neuropathy, posterior ischemic). The injury results from occlusion of arterial blood supply which may result from TEMPORAL ARTERITIS; ATHEROSCLEROSIS; COLLAGEN DISEASES; EMBOLISM; DIABETES MELLITUS; and other conditions. The disease primarily occurs in the sixth decade or later and presents with the sudden onset of painless and usually severe monocular visual loss. Anterior ischemic optic neuropathy also features optic disk edema with microhemorrhages. The optic disk appears normal in posterior ischemic optic neuropathy. (Glaser, Neuro-Ophthalmology, 2nd ed, p135)
Concepts Disease or Syndrome (T047)
MSH D018917
ICD9 377.41
ICD10 H47.01
SnomedCT 14357004
English Ischemic Optic Neuropathies, Ischemic Optic Neuropathy, Neuropathies, Ischemic Optic, Neuropathy, Ischemic Optic, Optic Neuropathies, Ischemic, Optic Neuropathy, Ischemic, AION - Ac ischaem optic neurop, ION - Ischaemic optic neurop, ION - Ischemic optic neurop, ischemic optic neuropathy (diagnosis), ischemic optic neuropathy, Optic ischaemic neuropathy, Optic ischemic neuropathy, Ischemia, Optic Nerve, Nerve Ischemia, Optic, Optic Nerve Ischemia, Ischemias, Optic Nerve, Nerve Ischemias, Optic, Optic Nerve Ischemias, Ischemic optic neuropthy, Optic Neuropathy, Ischemic [Disease/Finding], ischemic neuropathy optic, optic nerve ischemia, ischaemic optic neuropathy, Ischemic optic neuropathy, AION - Acute ischaemic optic neuropathy, AION - Acute ischemic optic neuropathy, ION - Ischaemic optic neuropathy, ION - Ischemic optic neuropathy, Ischaemic optic neuropathy, Ischemic optic neuropathy (disorder), ischemic; neuropathic, optic nerve
Dutch ischaemische opticus neuropathie, ischemische opticus neuropathie, ischemie; neuropathie, nervus opticus, opticus ischaemie neuropathie, Ischemische opticusneuropathie, Nervus-opticusneuropathie, Neuropathie, ischemische opticus-, Opticusneuropathie, ischemische
French Neuropathie ischémique optique, Neuropathie optique ischémique, Ischémie du nerf optique, NOI (Neuropathie Optique Ischémique), Névrite optique ischémique
Portuguese Neuropatia óptica isquémica, Nevrite óptica isquémica, Isquemia do Nervo Óptico, Neuropatia Óptica Isquêmica
Spanish Neuropatía isquémica óptica, neuropatía óptica isquémica (trastorno), neuropatía óptica isquémica, Neuropatía óptica isquémica, Isquemia del Nervio Óptico, Neuropatía Isquémica Óptica, Neuropatía Óptica Isquémica
Swedish Opticusneuropatier, ischemiska
Japanese キョケツセイシシンケイショウ, 虚血性視神経症, 視神経症-虚血性
Czech neuropatie optická ischemická, Ischemická optická neuropatie, Optická ischemická neuropatie, Oční ischemická neuropatie, ischemická optická neuropatie
Finnish Iskeeminen optikusneuropatia
Russian ZRITEL'NOGO NERVA NEVROPATIIA ISHEMICHESKAIA, ISHEMICHESKAIA NEVROPATIIA ZRITEL'NOGO NERVA, ISHEMICHESKAIA NEVROPATIIA ZRITEL'NOGO NERVA ZADNIAIA, ISHEMICHESKAIA NEVROPATIIA ZRITEL'NOGO NERVA PEREDNIAIA, ЗРИТЕЛЬНОГО НЕРВА НЕВРОПАТИЯ ИШЕМИЧЕСКАЯ, ИШЕМИЧЕСКАЯ НЕВРОПАТИЯ ЗРИТЕЛЬНОГО НЕРВА, ИШЕМИЧЕСКАЯ НЕВРОПАТИЯ ЗРИТЕЛЬНОГО НЕРВА ЗАДНЯЯ, ИШЕМИЧЕСКАЯ НЕВРОПАТИЯ ЗРИТЕЛЬНОГО НЕРВА ПЕРЕДНЯЯ
Italian Ischemia del nervo ottico, Neuropatia ottica ischemica
Croatian VIDNI ŽIVAC, NEUROPATIJA, ISHEMIJSKA, ISHEMIJSKA OPTIČKA NEUROPATIJA, OPTIČKA NEUROPATIJA, ISHEMIJSKA
Polish Neuropatia nerwu wzrokowego niedokrwienna
Hungarian Ischaemiás opticus neuropathia, Opticus ischaemiás neuropathia
Norwegian Synsnerveiskemi, Iskemisk opticusnevropati, Opticusnerveiskemi, Iskemisk optikusnevropati, Optikusnerveiskemi
German ischaemische Neuropathie des Nervus opticus, Ischämie des Optikusnervs, Ischämische Optikusneuropathie, Optikusneuropathie, ischämische