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Ischemic optic neuropathy
Last reviewed: 23.04.2024
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Ischemic opticoneuropathy is an infarction of the optic disc. The only symptom is a painless loss of vision. The diagnosis is established clinically. Treatment is ineffective.
There are two variants of the infarct of the optic nerve: non-artery and arteritis. The non-artery form, which usually affects people from 50 to 70 years, develops more often; loss of vision tends to be not as severe as in the arteritis variant, which usually happens in patients older than 70 years.
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What causes ischemic opticoneuropathy?
Most cases of ischemic opticoneuropathy are one-sided manifestation. Bilateral sequential diseases are observed in 20% of cases, but there is rarely a bilateral simultaneous involvement. Atherosclerotic narrowing of the posterior ciliary vessels, especially after an episode of hypotension, can promote non-arterial infarction of the optic nerve. Any inflammatory arteritis, especially temporal arteritis (see page 374), can cause an arterial form. It is important to diagnose the arteritis form not because you can do something to improve the condition of the diseased eye, but rather to initiate a preventive treatment for another eye.
Acute ischemia causes nerve edema, which further aggravates ischemia. A small excavation of the disk is a risk of developing non-arterial ischemic opticoneuropathy. There is usually no apparent medical condition that causes a non-artery variety, although some patients are diagnosed with diabetes and hypertension, which are considered to be risk factors. The loss of vision on waking causes the researchers to suspect postural hypotension as a potential cause of the non-artery effect.
Symptoms of ischemic optic neuropathy
The loss of vision in both options is usually sudden and painless. Some patients notice a loss of vision on waking. With temporal arteritis, there may be symptoms such as general malaise, muscle pain, headache over the temple and jaw obstruction, but these symptoms may not occur until the vision is lost. Visual acuity decreases, there is an afferent pupillary reflex. The disc of the optic nerve is swollen, with surrounding hemorrhages.
Diagnosis of ischemic optic neuropathy
Investigation of the field of vision often reveals a defect in the lower or central field of view. ESR is usually significantly accelerated in the arteritis variant and normal in non-artery form. A useful test is also the determination of the reactive protein. If a temporal arteritis is suspected, a temporal artery biopsy should be performed. For individual cases of progressive vision loss, CT or MRI should be performed to rule out common lesions. The most important aspect of the assessment is the exclusion of the arteritis variant, since the other eye is at risk if the treatment is not started quickly.
Treatment of ischemic optic neuropathy
There is no effective treatment, and in most cases, vision is not restored; However, in non-arteritis, 30% of patients recover spontaneously to some extent. Arteritis type lesions are treated with oral glucocorticoids (prednisolone at 80 mg / day) to prevent the disease of the other eye. Treatment should be delayed while waiting for the results of the biopsy. Treatment of a non-artery form with aspirin or glucocorticoids is not beneficial. Aids for low vision can be helpful.