What Is Anterior Ischemic Optic Neuropathy?

Disease Name: Anterior Ischemic Optic Neuropathy

Anterior ischemic optic neuropathy

Anterior ischemic optic neuropathy is caused by a lack of blood supply to the optic nerve papilla due to posterior ciliary artery circulation disorders, causing acute hypoxia and edema of the eye. The disease occurs in middle-aged and elderly people, and often develops in both eyes, with intervals of weeks, months, or years. Generally caused by hypertension, arteriosclerosis, diabetes, increased blood viscosity, severe anemia, low blood pressure, increased intraocular pressure and other factors.

Overview of anterior ischemic optic neuropathy

Disease Name: Anterior Ischemic Optic Neuropathy

Disease Classification: Ophthalmology

Key points for diagnosis:

1. Sudden loss of vision.

2. Fundus changes; early or partial vision of nipples becomes lighter, and edges are blurred. Was mild to moderate edema. There may be a small amount of bleeding in the optic nipple and nearby retina. Late optic nipple edema subsides, leaving some or all of the optic nipples pale, and retinal blood vessels becoming thinner.

3 Visual field change: it can be quadrant or semi-blind, but it is not bounded by horizontal or vertical midline, it is an arc-shaped visual field defect connected to the physiological blind spot.

4 Fluorescence angiography: Early showing of regional low fluorescence or delayed filling of the optic papilla, and slow or defective filling of the surrounding choroid. Capillary vessels leaked in the late lesions, showing strong fluorescence.

5. When the optic nerve atrophy occurs in one eye and the papillary edema occurs in the other eye, it should be distinguished from Foster-1 (ennedy syndrome).

treatment:

1. Etiology treatment.

2. Early application of corticosteroids can reduce exudation and edema caused by ischemia. Methods The same as optic papillitis.

3 Apply acetazamide to lower the intraocular pressure.

4 Application of vasodilators and multivitamins.

Description of anterior ischemic optic neuropathy

Anterior ischemic optic neuropathy is the ischemia of the small branches of the posterior ciliary blood vessels supplying the anterior and ethmoidal regions of the optic disc, causing local infarction of the optic disc. It is characterized by a sudden loss of vision, disc edema, and characteristic visual field defects (fan-shaped defects connected to physiological blind spots). Posterior ischemic optic neuropathy is mostly speculative due to lack of pathological confirmation, so it will not be repeated here.

Signs and symptoms of anterior ischemic optic neuropathy

1. Clinical manifestations

Suddenly, painless, non-progressive vision loss occurs. Kuaiji is one-onset disease, which can affect the other eye in weeks to years, and the age of onset is more than 50 years old. Fundus examination: most of the optic disc is localized grayish white edema, and there may be linear bleeding around the optic disc at the corresponding place, and the retinal nerve fiber layer defect will appear in the later stage. The early optic disc was slightly swollen and showed a reddish color, which was caused by the expansion of capillaries on the optic disc surface. The visual field defect is an arc-shaped or fan-shaped dark electricity connected to the physiological blind spot, which corresponds to the change of the optic disc. Temporal arteritis can be cord-like and tender, often without pulsation, and central retinal artery occlusion or cranial nerve palsy may occur (especially nerve VI paralysis).

Clinical Type

non-arterial inflammatory: or arteriosclerosis. It is more common in patients aged 40-60 years, and may have risk factors such as diabetes, hypertension, and hyperlipidemia. New pairs of nocturnal hypotension may play a role in this disease, especially in patients who are on appointment for hypertension medication. 25% -40% of the other eyes will also develop.

Arteritis: It is rarer than the former. It is mainly caused by temporal cell arteritis (GCA) ischemic optic neuropathy. It is more common in 70-80 year olds. His vision loss and optic disc edema are more obvious than the former, and can occur simultaneously in both eyes. If giant cell arteritis is suspected due to symptoms, signs or erythrocyte sedimentation, a temporal artery biopsy may be performed.

Causes of anterior ischemic optic neuropathy

local vascular lesions of the optic disc: such as ocular arterial inflammation, arteriosclerosis or embolization);

Increased blood viscosity: such as polycythemia, leukemia;

Low ophthalmic flow perfusion: such as general hypotension, carotid or arterial stenosis, acute blood loss; increased intraocular pressure.

Diagnosis of anterior ischemic optic neuropathy

1.Diagnosis

It can be diagnosed according to the characteristics of the disease, fundus and visual field examination. Good eye examination also helps to diagnose, so this disease is more common in those with small optic discs ignoring the cup.

2.Differential diagnosis

Optic neuritis (discitis): The patient is younger, the attack is not sudden, and there is pain in the rotation of the eyeballs. Therefore, this disease is more common in those with small optic discs who ignore the cup. There are often posterior vitreous cells.

Treatment of anterior ischemic optic neuropathy

1. For the treatment of systemic diseases, improve eye artery perfusion.

2. Systemic application of glucocorticoids to relieve edema and exudation caused by circulatory disorders is particularly important for arterial inflammation. If the clinical, blood, and CRP tests are considered to be arterial inflammatory ischemic optic neuropathy, glucocorticoid shock therapy should be used early in large doses to save patients' vision and prevent other eye attacks.

3. Intravenous infusion of vasodilators to improve microcirculation.

4. Oral acetazolamide reduces intraocular pressure and relatively increases intraocular pressure. But its role is still controversial.

Safety of anterior ischemic optic neuropathy

Patients with this disease are often elderly and can also be seen in the pre-senile period.

For those with diabetes, glucocorticoids are contraindicated. Aspirin (regular or once a day) is recommended because it can reduce the chance of good eye attacks. On the other hand, you should ensure that blood pressure does not drop sharply, which may cause vision deterioration or good eye involvement. You should also stop smoking.