ischemic optic neuropathy (stroke of the optic nerve)
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Etiology
(risk factors)
- hypertension (anterior*)
- diabetes mellitus (anterior*)
- combination of hypotension & anemia (posterior*)
- arteritis, giant-cell arteritis ... (5% of patients > 65)
- hyperlipidemia
- head injury: traumatic optic neuropathy (posterior*)
- blunt trauma to the superior orbital rim, lateral orbital rim, frontal area, or cranium
- pharmaceuticals
- sildenafil (Viagra) & other PDE5 inhibitors ?
- semaglutide[5]
* anterior vs posterior ischemic optic neuropathy
Epidemiology
- age > 40 years[3]
Pathology
- ischemia of posterior ciliary artery (anterior*)
- infarction of the retrobulbar optic nerve (posterior*)
- alternatively disease of the retina
- head injury result in ischemia & edema
Genetics
- allele B of platelet glycoprotein 1b-apha (GP1BA) is associated with susceptibility to nonarteritic anterior ischemic optic neuropathy
Clinical manifestations
- visual impairment
- sudden painless monocular visual loss
- blurry vision
- visual field defects often involving superior & inferior fields
- edema of optic disk with 1 day of visual symptoms
- flame-shaped splinter hemorrhages
- afferent pupillary defect
- affected pupil does not constrict to light
- both pupils will constrict to light upon the contralateral (unaffected) pupil
- affected pupil will dilate if the unaffected is no longer constricted
- vision is loss is generally worst at onset with little deterioration[3]
- occasional mild improvement in vision with time
Laboratory
Differential diagnosis
Management
- referral to an ophthalmologist
- generally no treatment available unless associated with arteritis
- glucocorticoids to prevent blindness in second eye in patients with arteritis
More general terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 166
- ↑ 3.0 3.1 3.2 Prescriber's Letter 12(6): 2005 Viagra and Vision Loss Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210611&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ O'Brien EK, eMedicine (Medscape) Optic Nerve Decompression for Traumatic Optic Neuropathy http://emedicine.medscape.com/article/868252-overview
- ↑ 5.0 5.1 Hathaway JT, Shah MP, Hathaway DB et al Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide. JAMA Ophthalmol. 2024 Jul 3. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38958939 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2820255