Ischemic Optic Neuropathy

From Anvita Health Wiki

Contents 1 Etiology 2 Epidemiology 3 Pathology 4 Genetics 5 Clinical-manifestations 6 Laboratory 7 Differential-diagnosis 8 Management 9 More General Terms 10 Internet Database 11 References

Etiology

• ( risk factors)
• hypertension (anterior*)
• diabetes mellitus (anterior*)
• combination of hypotension & anemia (posterior*)
• 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 ?
  

• * 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*)
• 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
• vision is loss is generally worst at onset with little deterioration [3]
• occasional mild improvement in vision with time

Laboratory

• erythrocyte sedimentation rate
• C-ractive protein ( arteritis)

Differential-diagnosis

• temporal arteritis

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

• optic neuropathy
• ischemia

Internet Database

OMIM: 258660

References

1. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
2. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 166
3. Prescriber's Letter 12(6): 2005 Viagra and Vision Loss Detail-Document#: [1] (subscription needed) [2]
4. O'Brien EK, eMedicine (Medscape) Optic Nerve Decompression for Traumatic Optic Neuropathy [3]

ischemic optic neuropathy (stroke of the optic nerve)