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Posteriorischemic Optic Neuropathy

 Syn. PION

Signs & Symptoms

 Acute loss of vision
Note: Occurring over hours to days
Ref: Uptodate [ Nonarteritic anterior ischemic optic neuropathy: Clinical features and diagnosis] Vaughan [ 642] BCSC [ 99]
Pain on ocular movement (negative symptom)
Ref: Uptodate [ Nonarteritic anterior ischemic optic neuropathy: Clinical features and diagnosis] BCSC [ 101]
Transient prodromal vision loss
Note: More common in giant cell arteritis than in NAION
Ref: Uptodate [ Nonarteritic anterior ischemic optic neuropathy: Clinical features and diagnosis] BCSC [ 99]
Transient prodromal diplopia
Note: More common in giant cell arteritis than in NAION
Ref: Uptodate [ Nonarteritic anterior ischemic optic neuropathy: Clinical features and diagnosis] BCSC [ 99]

Physical Examination

 Acute loss of vision
Note: Occurring over hours to days
Ref: Uptodate [ Nonarteritic anterior ischemic optic neuropathy: Clinical features and diagnosis] Vaughan [ 642] BCSC [ 99]
Hyperemic optic disc edema #Nonarteritic
Ref: Uptodate [ Nonarteritic anterior ischemic optic neuropathy: Clinical features and diagnosis] BCSC [ 99]
Optic atrophy
Note: Within 6–8 weeks of onset
Ref: Vaughan [ 643] BCSC [ 99]

Lab / Serology

 Anemia #Nonarteritic
Note: Nonarteritic Posterior ischemic optic neuropathy
Ref: Uptodate [ Posterior ischemic optic neuropathy]
Raised C-reactive protein #Arteritic
Note: Arteritic Anterior Ischemic Optic Neuropathy,arteritic posterior ischemic optic neuropathy
Ref: Uptodate [ Nonarteritic anterior ischemic optic neuropathy: Clinical features and diagnosis, Posterior ischemic optic neuropathy] Vaughan [ 645] BCSC [ 99]
Raised Erythrocyte sedimentation rate #Arteritic
Note: Arteritic Anterior Ischemic Optic Neuropathy,arteritic posterior ischemic optic neuropathy
Ref: Uptodate [ Nonarteritic anterior ischemic optic neuropathy: Clinical features and diagnosis, Posterior ischemic optic neuropathy] Vaughan [ 645] BCSC [ 99]

Imagin Study

 Enhancement of the optic nerve (negative symptom)
Note: 95 percent of patients with optic neuritis will demonstrate gadolinium contrast enhancement of the optic nerve, this is relatively unusual (<10 percent) in NAION
Ref: Uptodate [ Nonarteritic anterior ischemic optic neuropathy: Clinical features and diagnosis] BCSC [ 101]

Complication

Risk Factors

 Active Smoking
Ref: Uptodate [ Nonarteritic anterior ischemic optic neuropathy: Epidemiology, pathogenesis, and etiologies, Posterior ischemic optic neuropathy]
Tobacco
Ref: Uptodate [ Nonarteritic anterior ischemic optic neuropathy: Epidemiology, pathogenesis, and etiologies, Posterior ischemic optic neuropathy]
Passive Smoking
Ref: Uptodate [ Nonarteritic anterior ischemic optic neuropathy: Epidemiology, pathogenesis, and etiologies, Posterior ischemic optic neuropathy]

Cause

 Vasospasm #Nonarteritic
Note: Nonarteritic Posterior ischemic optic neuropathy, due to Migraine drugs, due to vasoactive stimulant drugs, due to methamphetamine
Ref: Uptodate [ Posterior ischemic optic neuropathy]
Radiotherapy
Note: Usually treatment for skull base or sinus tumors 12–18 months previously
Ref: Vaughan [ 646]
Mucormycosis
Ref: Vaughan [ 646]

Other