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The Many Paths of Acute Optic Neuropathy

The most common acute optic neuropathies include ischemic optic neuropathy (ION), optic neuritis and trauma.

In patients ages 50 and up, acute anterior ischemic optic neuropathy (AION) is the most common presentation. AION is divided further into non-arteritic (NAION) and arteritic (AAION). AAION is the ocular manifestation of giant cell arteritis (GCA), also known as temporal arteritis. Another variant of ION is posterior ischemic neuropathy (PION), an infarction of the posterior portion of the optic nerve(s). To provide the most effective treatment for patients, it is crucial to understand each of these subtypes, because the underlying cause, disease progression and management…

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 Clinical approach to optic neuropathies

The mode of onset of visual loss is an important clue to the etiology of the optic neuropathy. Rapid onset is characteristic of optic neuritis, ischemic optic neuropathy, inflammatory (non-demyelinating) and traumatic optic neuropathy. A gradual onset over months is typical of compressive toxic/nutritional optic neuropathy. A more protracted history over years is seen in compressive and hereditary optic neuropathies.

 Optic Neuropathy: Symptoms, Causes & Treatment

Optic neuropathy is a catch-all term that refers to damage inflicted on the optic nerve in your eye. This is the nerve in the back of the eyeball that transfers visual information from your eye to the brain, allowing you to see. This condition is one that gets worse over time, when not treated. Also known as non-arteritic anterior ischemic optic neuropathy (NAION), this condition required urgent medical attention.

Articles of Interest

Compressive Optic Neuropathy

Patients with CON usually present with chronic progressive vision loss. It can be in one or both eyes. They can present with headaches, nausea, vomiting, diplopia, dyschromatopsia, exophthalmos, afferent pupillary defect, photophobia, red-eye, or unexplained weight loss.

Diagnosing and Managing Ischemic Optic Neuropathy

The arteritic form is treated with corticosteroids, while there is still no widely accepted treatment for the nonarteritic form.

Drug-Induced Optic Neuropathy

Optic neuropathies can be either hereditary or acquired. Acquired etiologies of optic neuropathy include ischemic, nutritional, and toxic types. Drug-induced optic neuropathy is of the toxic type. Mechanisms of drug-induced optic neuropathy include mitochondrial dysfunction, disruption of blood flow to the optic nerve, and unknown mechanisms.

Hereditary optic neuropathies

The most common hereditary optic neuropathies are autosomal dominant optic atrophy (Kjer's disease) and maternally inherited Leber's hereditary optic neuropathy.

Nutritional Optic Neuropathy

Nutritional optic neuropathy is characterized by bilateral, symmetric, cecocentral scotomas, an acquired disturbance of color vision (usually dulling of the color red), and either a normal fundus morphology or tortuosity of small retinal vessels within the nerve fiber layer.

Optic Neuropathy after COVID-19

In ION, it has been hypothesized that these factors in COVID19 (inflammatory response, hypercoagulable state, and hypoxemia) may lead to thrombosis of the blood vessels (e.g., ciliary vessels) supplying the optic nerve and subsequent ischemia of the optic nerve. However, there have been no studies to confirm this pathogenesis.

Optic Neuropathy Part II: Ischemic, Compressive, Hereditary

This is our second Orbis webinar concerning optic neuropathy. So last month, we talked about inflammatory and infectious optic neuropathies, and that webinar was recorded and should be on Cybersight for you to review,

Optic Neuropathy: Do You Know the Signs?

Optic neuropathy has various causes, each with different symptoms. For example, sometimes visual loss is very gradual, other times a patient wakes up one day and suddenly can’t see. Sometimes it impacts color vision, where colors start to seem less bright or washed out. Sometimes it presents inconsistently...

What Is Ischemic Optic Neuropathy?

If blood flow to your optic nerve is reduced, your vision will darken for a few seconds or minutes then return to normal. This is called a transient ischemic attack (TIA).

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StatPearls

The optic nerve may be damaged by ischemia anywhere along its path, starting from its origin. It is mainly divided into anterior and posterior. A portion of the optic nerve between the retina and sclera is supplied by a network of 6 to 12 short posterior ciliary arteries at the back of the globe. Optic ischemia is a serious vision-threatening disease. It leads to vision loss in both eyes sequentially if not treated in time.