|ANTERIOR ISCHEMIC OPTIC NEUROPATHY (AION)
SIGNS AND SYMPTOMS
The patient generally has significant systemic disease. In the case of non-arteritic anterior ischemic optic neuropathy, the patient usually has a systemic vascular disease (hypertension, diabetes, atherosclerosis) or collagen vascular disease. In the arteritic form of the disease, the patient will usually present with early signs of anorexia, weight loss, decreased appetite, jaw claudication, scalp tenderness and malaise.
Often several instances of amaurosis fugax (transient blindness) may precede the arteritic AION by up to six months. This is due to giant cell arteritis (GCA), an idiopathic systemic inflammation of medium-sized arteries. The patient with arteritic AION is, on average, 75 years old while the patient with non-arteritic AION is, on average age, 62 years old. Non-arteritic patients will present with a relative afferent pupil defect and a swollen, hyperemic optic disc. Patients with the arteritic form will present also with afferent pupil defect, but the swollen disc is usually pale with associated splinter hemorrhages.
If the patient is either suspected to have, or diagnosed with, GCA and arteritic AION, begin treatment with systemic steroids to prevent vision loss from progressing to the other eye. Typically, it's best to hospitalize the patient and place him or her on 1-2g I.V. methylprednisolone for two to three days, followed by oral steroids (60 to 100mg QD of prednisone). Following hospital release, taper the oral steroids but maintain therapy for two to four years. Despite aggressive therapy, GCA frequently progresses to the fellow eye, giving this disease a poor prognosis.
In the case of non-arteritic AION, the prognosis is guarded but much better than with arteritic AION. The rate of progression to bilateral involvement is significantly lower (32 months, on average). There is no direct treatment for non-arteritic AION or the vasculopathy that causes it. The systemic vascular diseases that precipitate the condition must be well controlled by the patient's internist in hopes of preventing or delaying bilateral involvement.
Other reports in this section
Eyelids & Eyelashes | Conjunctiva & Sclera | Cornea
Uvea | Vitreous & Retina | Optic Nerve & Brain | Oculosystemic Disease
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