Arteritic anterior ischemic optic neuropathy

Arteritic Anterior Ischemic Optic Neuropathy

Arteritic Anterior Ischemic Optic Neuropathy (AAION) is a medical condition characterized by sudden vision loss due to inflammation and subsequent ischemia of the optic nerve head. It is most commonly associated with Giant Cell Arteritis (GCA), an inflammatory disease of blood vessels.

Pathophysiology

AAION occurs when the blood supply to the optic nerve is compromised due to inflammation of the arteries, particularly the short posterior ciliary arteries. This inflammation is typically caused by Giant Cell Arteritis, which leads to narrowing and occlusion of the vessels, resulting in ischemia and damage to the optic nerve.

Clinical Presentation

Patients with AAION often present with sudden, painless vision loss in one eye, which may progress to the other eye if left untreated. Other symptoms may include:

• Scalp tenderness
• Jaw claudication
• Temporal headache
• Systemic symptoms such as fever, malaise, and weight loss

Diagnosis

The diagnosis of AAION is primarily clinical but can be supported by laboratory and imaging studies:

• Elevated Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP)
• Temporal artery biopsy showing inflammation with giant cells
• Fundoscopic examination revealing a pale, swollen optic disc

Treatment

Immediate treatment is crucial to prevent further vision loss. High-dose corticosteroids are the mainstay of treatment to reduce inflammation and prevent further ischemic damage. The typical regimen involves intravenous methylprednisolone followed by oral prednisone.

Prognosis

The prognosis for vision recovery in AAION is generally poor, with many patients experiencing permanent vision loss. However, early diagnosis and treatment can prevent involvement of the second eye and systemic complications of GCA.

Also see

• Non-arteritic Anterior Ischemic Optic Neuropathy
• Giant Cell Arteritis
• Optic Neuritis
• Temporal Arteritis