These are pictures of Anterior Ischemic Optic Neuropathy. This is a part in Fundoscopic findings of the Atlas of Emergency Medicine book
Clinical Summary
Anterior ischemic optic neuropathy (AION) presents with a sudden loss of visual field (often altitudinal), usually involving fixation, in an older individual. The loss is usually stable after onset, with no improvement, and only occasionally, progressive over several days to weeks. Pale disk swelling is present involving a sector or the full disk, with accompanying flame hemorrhages. The cup to disc ratio is typically small (0.1-0.2) bilaterally.
The common, nonarteritic causes of AION (probably arteriosclerosis) need to be differentiated from arteritic ones, such as giant cell arteritis. If untreated, the latter will involve the other eye in 75% of cases, often in a few days to weeks. These elderly individuals often have weight loss, masseter claudication, weakness, myalgias, elevated sedimentation rate, and painful scalp, temples, or forehead.
Management and Disposition
Routine ophthalmologic and medical evaluation is appropriate.
Pearls
1. Consider AION in an elderly patient with sudden, usually painless, visual field loss.
2. Rule out giant cell arteritis. These patients tend to be older (age > 55 years) and may have associated CRAO or cranial nerve palsies (III, IV, or VI) with diplopia.
FIGURE 3.28 ■ Anterior Ischemic Optic Neuropathy. Pale disk swelling and flame hemorrhages are present. This patient also has an unrelated retinal scar owing to toxoplasmosis.
REFERENCES
The Atlas of Emergency Medicine, Fourth Edition, 2016.
COMMENTS