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Anterior ischemic optic neuropathy (AION)

Anterior ischemic optic neuropathy (AION). Most common over 50 years Painless monocular over hours to days Visual acuity Visual field APD. AION. Arteritic AION is associated with giant cell arteries (GCA) Nonarteritic AION. AAION. Is less frequent 5-10% Older patients (mean 70yr)

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Anterior ischemic optic neuropathy (AION)

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  1. Anterior ischemic optic neuropathy (AION) • Most common over 50 years • Painless monocular over hours to days • Visual acuity • Visual field • APD

  2. AION • Arteritic AION is associated with giant cell arteries (GCA) • Nonarteritic AION

  3. AAION • Is less frequent 5-10% • Older patients (mean 70yr) • Inflammatory and thrombotic occlusion post. Cilliary artery • Systemic symptoms

  4. Systemic Findings of GCA • Are usually present • Headache, temporal and scalp tenderness • Jaw claudication • Malaise, anorexia, weight loss, fever, joint & muscle pain • Ear pain

  5. AAION • Sever visual loss • Pale edema • Cotton wool spot • F.A. delayed choroidal filling • Normal cup.

  6. Treating AAION • Immediate therapy is critical • Temporal artery biopsy may delayed treat • IV prednisolone 1 g/day for 3-5 days • Then oral prednisolone 100 mg/day tapered 3-12 month or more

  7. Major Goals of Therapy • Prevent contralateral visual loss • Fellow eye involved 95% days or weeks • Affected eye improve somewhat • Avoid systemic vascular complication • Risk of recurrence is 7% so tapering must be slow and careful

  8. Nonarteritic Anterior ISchemic Optic Neuropathy (NAION) • More common 90-95% of AION • In younger age groups (mean age 60yr) • Related to optic disc microcirculation • On awakening, noctural systemic Hypotension • Systemic symptoms are absent

  9. NAION • V.A. > 20/200 in over 60% of cases • Palor is less common • Optic disk in other eye is small and small or absent cup. • 5 yr risk of other eye is 14.7% (psued-foster kennedy syd)

  10. Risk Factors of NAION • Crowding of disk (disk at risk) • Systemic hypertension • Diabetes (young) • Smoking, hyperlipidemia • Hyperhomocysteinemia, platelet polymorphism, sleep apnea • Phosphodiestrase inhibitors (sildenafil or viagra) ?? Hypotensive effect

  11. Differential Diagnosis of NAION • Optic neuritis • Infiltrative optic neuropathies • Anterior orbital lesion • Diabetic papillopathy

  12. NAION Optic neurtis

  13. Treatment of NAION • Untreated case remain stable but recovery of 3 lines 31% after 2 years • Recurrence unusual 6.4% • No proven therapy surgery no benefit • No proven prophylaxis • Asprin reducing incidence of fellow eye is unclear

  14. summary

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