ABSTRACT
Ischemic optic neuropathies (IONs) are the most frequent acute optic neuropathy in patients older than 50 years. They are classified according to the location of the ischemic damage into anterior ION and posterior ION. Ischemic optic neuropathies may also be categorized based on the presence or absence of temporal arteritis as an underlying etiology. Anterior ION presents with sudden, painless visual loss developing over hours to days. Examination findings usually include decreased visual acuity, a visual field defect, color vision loss, a relative afferent pupillary defect, and a swollen optic nerve head. Posterior ION occurs in arteritic, nonarteritic, and surgical settings. It is characterized by acute vision loss without initial disc edema but with subsequent optic disc atrophy.
KEYWORDS
Optic neuropathy - arteritic - nonarteritic
REFERENCES
-
1
Rucker J C, Biousse V, Newman N J.
Ischemic optic neuropathies.
Curr Opin Neurol.
2004;
17
27-35
-
2
Onda E, Cioffi G A, Bacon D R, Van Buskirk E M.
Microvasculature of the human optic nerve.
Am J Ophthalmol.
1995;
120
92-102
-
3
Hayreh S S, Podhajsky P A, Zimmerman B.
Giant cell arteritis: validity and reliability of various diagnostic criteria.
Am J Ophthalmol.
1997;
123
285-296
-
4
Liu N H, LaBree L D, Feldon S E, Rao N A.
The epidemiology of giant cell arteritis: a 12-year retrospective study.
Ophthalmology.
2001;
108
1145-1149
-
5
Tomsak R L.
Giant cell arteritis.
Ophthalmology.
2002;
109
219-220
-
6
Hayreh S S, Zimmerman B.
Management of giant cell arteritis-our 27-year clinical study: new light on old controversies.
Ophthalmologica.
2003;
217
239-259
-
7
Guyer D R, Miller N R, Auer C L, Fine S L.
The risk of cerebrovascular and cardiovascular disease in patients with anterior ischemic optic neuropathy.
Arch Ophthalmol.
1985;
103
1136-1142
-
8
Henkind P, Charles N C, Pearson J.
Histopathology of ischemic optic neuropathy.
Am J Ophthalmol.
1970;
69
78-90
-
9
Rootman J, Butler D.
Ischaemic optic neuropathy: a combined mechanism.
Br J Ophthalmol.
1980;
64
826-831
-
10
Nordborg E, Nordborg C.
Giant cell arteritis: epidemiology clues to its pathogenesis and an update on its treatment.
Rheumatology.
2003;
42
413-421
-
11
Liu G T, Glaser J S, Schatz N J, Smith J L.
Visual morbidity in giant cell arteritis.
Ophthalmology.
1994;
101
1779-1785
-
12
Aiello P D, Trautmann J C, McPhee T J, Kunselman A R, Hunder G G.
Visual prognosis in giant cell arteritis.
Ophthalmology.
1993;
100
550-555
-
13
Repka M X, Savino P J, Schatz N J, Sergott R C.
Clinical profile and long-term implications of anterior ischemic optic neuropathy.
Am J Ophthalmol.
1983;
96
478-483
-
14
Hayreh S S, Podhajsky P A, Zimmerman B.
Ocular manifestation of giant cell arteritis.
Am J Ophthalmol.
1998;
125
509-520
-
15
Hayreh S S.
Anterior ischemic optic neuropathy: differentiation of arteritic from nonarteritic type and its management.
Eye.
1990;
4
25-41
-
16
Siatkowski R M, Gass J D, Glaser J S, Smith J L, Schatz N J, Schiffman J.
Fluorescein angiography in the diagnosis of giant cell arteritis.
Am J Ophthalmol.
1993;
115
57-63
-
17
Melberg N S, Grand M G, Dieckert P J.
Cotton-wool spots and the early diagnosis of giant cell arteritis.
Ophthalmology.
1995;
102
1611-1614
-
18
Arnold A C, Hepler R S.
Fluorescein angiography in acute nonarteritic anterior ischemic optic neuropathy.
Am J Ophthalmol.
1994;
117
222-230
-
19
Arnold A C, Badr M A, Hepler R S.
Fluorescein angiography in nonischemic optic disc edema.
Arch Ophthalmol.
1996;
114
293-298
-
20
Mack H G, O'Day J, Currie J N.
Delayed choroidal perfusion in giant cell arteritis.
J Clin Neuroophthalmol.
1991;
11
221-227
-
21
Hayreh S S, Podhajsky P A, Raman R, Zimmerman B.
Giant cell arteritis: validity and reliability of various diagnostic criteria.
Am J Ophthalmol.
1997;
123
285-296
-
22
Jones J G, Hazleman B L.
Prognosis and management of polymyalgia rheumatica.
Ann Rheum Dis.
1981;
40
1-5
-
23
Miller A, Green M, Robinson D.
Simple rule for calculating normal erythrocyte sedimentation rate.
Br Med J (Clin Res Ed).
1983;
286
266
-
24
Zweegman S, Makkink B, Stehouwer C D.
Giant cell arteritis with normal erythrocyte sedimentation rate: case report and review of the literature.
Neth J Med.
1993;
42
128-131
-
25
Small J M, Gavrilescu K.
The serum protein changes in giant cell arteritis.
J Neurol Neurosurg Psychiatry.
1963;
26
257-261
-
26
Eshaghian J, Goeken J A.
C-reactive protein in giant cell (cranial, temporal) arteritis.
Ophthalmology.
1980;
87
1160-1166
-
27
Krishna R, Kosmorsky G S.
Implications of thrombocytosis in giant cell arteritis.
Am J Ophthalmol.
1997;
124
103
-
28
Liozon E, Herrmann F, Ly K et al..
Risk factors for visual loss in giant cell (temporal) arteritis: a prospective study of 174 patients.
Am J Med.
2001;
111
211-217
-
29
Albert D M, Ruchman M C, Keltner J L.
Skip lesion in temporal arteritis.
Arch Ophthalmol.
1976;
94
2072-2077
-
30
McDonnell P J, Moore G W, Miller N R, Hutchins G M, Green W R.
Temporal arteritis: a clinicopathologic study.
Ophthalmology.
1986;
93
518-530
-
31
Hunder G G, Sheps S G, Allen G L, Joyce J W.
Daily and alternate-day corticosteroid regimens in treatment of giant cell arteritis: comparison in a prospective study.
Ann Intern Med.
1975;
82
613-618
-
32
Hedges 3rd T R, Gieger G L, Albert D M.
The clinical value of negative temporal artery biopsy specimens.
Arch Ophthalmol.
1983;
101
1251-1254
-
33
Guevara R A, Newman N J, Grossniklaus H E.
Positive temporal artery biopsy 6 months after prednisone treatment.
Arch Ophthalmol.
1998;
116
1252-1253
-
34
Chan C C, Paine M, O'Day J.
Steroid management in giant cell arteritis.
Br J Ophthalmol.
2001;
85
1061-1064
-
35
Hayreh S S, Zimmerman B, Kardon R H.
Visual improvement with corticosteroid therapy in giant cell arteritis: report of a large study and review of the literature.
Acta Ophthalmol Scand.
2002;
80
355-367
-
36
Foroozan R, Deramo V A, Buono L M et al..
Recovery of visual function in patients with biopsy-proven giant cell arteritis.
Ophthalmology.
2003;
110
539-542
-
37
Beri M, Klugman M R, Kohler J A, Hayreh S S.
Anterior ischemic optic neuropathy: VII. Incidence of bilaterality and various influencing factors.
Ophthalmology.
1987;
94
1020-1028
-
38
Miller N R, Keltner J L, Gittinger J W.
Giant cell (temporal) arteritis: the differential diagnosis.
Surv Ophthalmol.
1979;
23
259-263
-
39
Hayreh S S, Zimmerman B.
Visual deterioration in giant cell arteritis patients while on high doses of corticosteroid therapy.
Ophthalmology.
2003;
110
1204-1215
-
40
Spiera R F, Mitnick H J, Kupersmith M.
A prospective, double-blind, randomized, placebo controlled trial of methotrexate in the treatment of giant cell arteritis (GCA).
Clin Exp Rheumatol.
2001;
19
495-501
-
41
Jover J A, Hernandez Garcia C, Morado I C, Vargas E, Banares A, Fernandez-Gutierrez B.
Combined treatment of giant-cell arteritis with methotrexate and prednisone: a randomized, double-blind, placebo-controlled trial.
Ann Intern Med.
2001;
134
106-114
-
42
Hoffman G S, Cid M C, Hellmann D B et al..
A multicenter, randomized, double-blind, placebo-controlled trial of adjuvant methotrexate treatment for giant cell arteritis.
Arthritis Rheum.
2002;
46
1309-1318
-
43
Nesher G, Berkun Y, Mates M, Baras M, Rubinow A, Sonnenblick M.
Low-dose aspirin and prevention of cranial ischemic complications in giant cell arteritis.
Arthritis Rheum.
2004;
50
1332-1337
-
44
Weyand C M, Kaiser M, Yang H.
Therapeutic effects of acetylsalicylic acid in giant cell arteritis.
Arthritis Rheum.
2002;
46
457-466
-
45
Borruat F X, Herbort C P.
Herpes zoster ophthalmicus: anterior ischemic optic neuropathy and acyclovir.
J Clin Neuroophthalmol.
1992;
12
37-40
-
46
Isaak B L, Liesegang T J, Michet Jr C J.
Ocular and systemic findings in relapsing polycondritis.
Ophthalmology.
1986;
93
681-689
-
47
Crompton J L, Iyer P, Begg M W.
Vasculitis and ischaemic optic neuropathy associated with rheumatoid arthritis.
Aust J Ophthalmol.
1980;
8
219-230
-
48
Hsu C T, Kerrison J B, Miller N R, Goldberg M F.
Choroidal infarction, anterior ischemic optic neuropathy, and central retinal artery occlusion from polyarteritis nodosa.
Retina.
2001;
21
348-351
-
49
Kattah J C, Chrousos G A, Katz P A, McCasland B, Kolsky M P.
Anterior ischemic optic neuropathy in Churg-Strauss syndrome.
Neurology.
1994;
44
2200-2202
-
50
Ischemic Optic Neuropathy Decompression Trial Research Group .
Characteristics of patients with nonarteritic anterior ischemic optic neuropathy eligible for the Ischemic Optic Neuropathy Decompression Trial.
Arch Ophthalmol.
1996;
114
1366-1374
-
51
Hattenhauer M G, Leavitt J A, Hodge D O, Grill R, Gray D T.
Incidence of nonarteritic anterior ischemic optic neuropathy.
Am J Ophthalmol.
1997;
123
103-107
-
52
Boghen D R, Glaser J S.
Ischaemic optic neuropathy: the clinical profile and history.
Brain.
1975;
98
689-708
-
53
Hayreh S S, Joos K M, Podhajsky P A, Long C R.
Systemic diseases associated with nonarteritic anterior ischemic optic neuropathy.
Am J Ophthalmol.
1994;
118
766-780
-
54
Chutorian A M, Winterkorn J M, Geffner M.
Anterior ischemic optic neuropathy in children: case report and review of the literature.
Pediatr Neurol.
2002;
26
358-364
-
55
Rizzo III J F, Lessell S.
Optic neuritis and ischemic optic neuropathy: overlapping clinical profiles.
Arch Ophthalmol.
1991;
109
1668-1672
-
56
Swartz N G, Beck R W, Savino P J et al..
Pain in anterior ischemic optic neuropathy.
J Neuroophthalmol.
1995;
15
9-10
-
57
Cheng M A, Sigurdson W, Tempelhoff R, Lauryssen C.
Visual loss after spine surgery: a survey.
Neurosurgery.
2000;
46
625-630
-
58
Boone M I, Massry G G, Frankel R A, Holds J B, Chung S M.
Visual outcome in bilateral nonarteritic anterior ischemic optic neuropathy.
Ophthalmology.
1996;
103
1223-1228
-
59
Olver J M, Spalton D J, McCartney A C.
Microvascular study of the retrolaminar optic nerve in man: the possible significance in anterior ischaemic optic neuropathy.
Eye.
1990;
4
7-24
-
60
Jonas J B, Gusek G C, Naumann G O.
Anterior ischemic optic neuropathy: nonarteritic form in small and giant cell arteritis in normal sized optic discs.
Int Ophthalmol.
1988;
12
119-125
-
61
Mansour A M, Shoch D, Logani S.
Optic disk size in ischemic optic neuropathy.
Am J Ophthalmol.
1988;
106
587-589
-
62
Feit R H, Tomsak R L, Ellenberger Jr C.
Structural factors in the pathogenesis of ischemic optic neuropathy.
Am J Ophthalmol.
1984;
98
105-108
-
63
Beck R W, Savino P J, Repka M X, Schatz N J, Sergott R C.
Optic disc structure in anterior ischemic optic neuropathy.
Ophthalmology.
1984;
91
1334-1337
-
64
Doro S, Lessell S.
Cup-disc ratio and ischemic optic neuropathy.
Arch Ophthalmol.
1985;
103
1143-1144
-
65
Burde R M.
Optic disk risk factors for nonarteritic anterior ischemic optic neuropathy.
Am J Ophthalmol.
1993;
116
759-764
-
66
Hayreh S S, Zimmerman B.
Visual field abnormalities in nonarteritic anterior ischemic optic neuropathy: their pattern and prevalence at initial examination.
Arch Ophthalmol.
2005;
123
1554-1562
-
67
Arnold A C, Hepler R S.
Natural history of nonarteritic anterior ischemic optic neuropathy.
J Neuroophthalmol.
1994;
14
66-69
-
68
Yee R D, Selky A K, Purvin V A.
Outcomes of optic nerve sheath decompression for nonarteritic ischemic optic neuropathy.
J Neuroophthalmol.
1994;
14
70-76
-
69
Sawle G V, James C B, Russell R W.
The natural history of non-arteritic anterior ischaemic optic neuropathy.
J Neurol Neurosurg Psychiatry.
1990;
53
830-833
-
70
Newman N J, Scherer R, Langenberg P et al..
Ischemic Optic Neuropathy Decompression Trial Research Group. The fellow eye in NAION: report from the ischemic optic neuropathy decompression trial follow-up study.
Am J Ophthalmol.
2002;
134
317-328
-
71
Cheng M A, Sigurdson W, Tempelhoff R, Lauryssen C.
Visual loss after spine surgery: a survey.
Neurosurgery.
2000;
46
625-630
-
72
Williams E L, Hart Jr W M, Tempelhoff R.
Postoperative ischemic optic neuropathy.
Anesth Analg.
1995;
80
1018-1029
-
73
Hayreh S S, Podhajsky P A, Zimmerman B.
Ipsilateral recurrence of nonarteritic anterior ischemic optic neuropathy.
Am J Ophthalmol.
2001;
132
734-742
-
74
Arnold A C.
Pathogenesis of nonarteritic anterior ischemic optic neuropathy.
J Neuroophthalmol.
2003;
23
157-163
-
75
Hayreh S S, Zimmerman M B, Podhajsky P, Alward W L.
Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders.
Am J Ophthalmol.
1994;
117
603-624
-
76
Landau K, Winterkorn J M, Mailloux L U, Vetter W, Napolitano B.
24-hour blood pressure monitoring in patients with anterior ischemic optic neuropathy.
Arch Ophthalmol.
1996;
114
570-575
-
77
Mojon D S, Hedges III T R, Ehrenberg B et al..
Association between sleep apnea syndrome and nonarteritic anterior ischemic optic neuropathy.
Arch Ophthalmol.
2002;
120
601-605
-
78
Lee A G, Kohnen T, Ebner R et al..
Optic neuropathy associated with laser in situ keratomileusis.
J Cataract Refract Surg.
2000;
26
1581-1584
-
79
Hayreh S S.
Anterior ischemic optic neuropathy: IV. Occurrence after cataract extraction.
Arch Ophthalmol.
1980;
98
1410-1416
-
80
Kim R, Van Stavern G, Juzych M.
Nonarteritic anterior ischemic optic neuropathy associated with acute glaucoma secondary to Posner-Schlossman syndrome.
Arch Ophthalmol.
2003;
121
127-128
-
81
Chiari M, Manzoni G C, Van de Geijn E J.
Ischemic optic neuropathy after sumatriptan in a migraine with aura patient.
Headache.
1994;
34
237-238
-
82
Egan R, Pomeranz H.
Sildenafil (Viagra) associated anterior ischemic optic neuropathy.
Arch Ophthalmol.
2000;
118
291-292
-
83
Hayreh S S.
Erectile dysfunction drugs and non-arteritic anterior ischemic optic neuropathy: is there a cause and effect relationship?.
J Neuroophthalmol.
2005;
25
295-298
-
84
Nagra P K, Foroozan R, Savino P J, Castillo I, Sergott R C.
Amiodarone induced optic neuropathy.
Br J Ophthalmol.
2003;
87
420-422
-
85
Fivgas G D, Newman N J.
Anterior ischemic optic neuropathy following the use of a nasal decongestant.
Am J Ophthalmol.
1999;
127
104-106
-
86
Kerrison J B.
Optic neuropathies caused by toxins and adverse drug reactions.
Ophthalmol Clin North Am.
2004;
17
481-488
-
87
Weger M, Stanger O, Deutschmann H et al..
Hyperhomocyst(e)inaemia, but not MTHFR C677T mutation, as a risk factor for non-arteritic ischaemic optic neuropathy.
Br J Ophthalmol.
2001;
85
803-806
-
88
Kawasaki A, Purvin V A, Burgett R A.
Hyperhomocysteinaemia in young patients with non-arteritic anterior ischaemic optic neuropathy.
Br J Ophthalmol.
1999;
83
1287-1290
-
89
Biousse V, Kerrison J B, Newman N J.
Is non-arteritic anterior ischaemic optic neuropathy related to homocysteine?.
Br J Ophthalmol.
2000;
84
555
-
90
Salomon O, Huna-Baron R, Kurtz S et al..
Analysis of prothrombotic and vascular risk factors in patients with nonarteritic anterior ischemic optic neuropathy.
Ophthalmology.
1999;
106
739-742
-
91
Knox D L, Kerrison J B, Green W R.
Histopathologic studies of ischemic optic neuropathy.
Trans Am Ophthalmol Soc.
2000;
98
203-220
-
92
Sergott R C, Cohen M S, Bosley T M, Savino P J.
Optic nerve decompression may improve the progressive form of nonarteritic ischemic optic neuropathy.
Arch Ophthalmol.
1989;
107
1743-1754
-
93
Spoor T C, Wilkinson M J, Ramocki J M.
Optic nerve sheath decompression for the treatment of progressive nonarteritic ischemic optic neuropathy.
Am J Ophthalmol.
1991;
111
724-728
-
94
Kelman S E, Elman M J.
Optic nerve sheath decompression for nonarteritic ischemic optic neuropathy improves multiple visual function measurements.
Arch Ophthalmol.
1991;
109
667-671
-
95
The Ischemic Optic Neuropathy Decompression Trial Research Group .
Optic nerve decompression surgery for nonarteritic anterior ischemic optic neuropathy (NAION) is not effective and may be harmful.
JAMA.
1995;
273
625-632
-
96
Keltner J L, Becker B, Gay A J, Podos S M.
Effect of diphenylhydantoin in ischemic optic neuritis.
Trans Am Ophthalmol Soc.
1972;
70
113-130
-
97
Ellenberger Jr C, Burde R M, Keltner J L.
Acute optic neuropathy: treatment with diphenylhydantoin.
Arch Ophthalmol.
1974;
91
435-438
-
98
Kollarits C R, McCarthy R W, Corrie W S, Swann E R.
Norepinephrine therapy of ischemic optic neuropathy.
J Clin Neuroophthalmol.
1981;
1
283-288
-
99
Smith J L.
Norepinephrine therapy of ischemic optic neuropathy.
J Clin Neuroophthalmol.
1981;
1
289-290
-
100
Johnson L N, Guy M E, Krohel G B, Madsen R W.
Levodopa may improve vision loss in recent-onset, nonarteritic anterior ischemic optic neuropathy.
Ophthalmology.
2000;
107
521-526
-
101
Kupersmith M J, Frohman L, Sanderson M et al..
Aspirin reduces the incidence of second eye NAION: a retrospective study.
J Neuroophthalmol.
1997;
17
250-253
-
102
Salomon O, Huna-Baron R, Steinberg D M, Kurtz S, Seligsohn U.
Role of aspirin in reducing the frequency of second eye involvement in patients with non-arteritic anterior ischaemic optic neuropathy.
Eye.
1999;
13
357-359
-
103
Beck R W, Hayreh S S, Podhajsky P A, Tan E S, Moke P S.
Aspirin therapy in nonarteritic anterior ischemic optic neuropathy.
Am J Ophthalmol.
1997;
123
212-217
-
104
Soheilian M, Koochek A, Yazdani S, Peyman G A.
Transvitreal optic neurotomy for nonarteritic anterior ischemic optic neuropathy.
Retina.
2003;
23
692-697
-
105
Arnold A C, Levin L A.
Treatment of ischemic optic neuropathy.
Semin Ophthalmol.
2002;
17
39-46
-
106
Jonas J B, Spandau U H, Harder B, Sauder G.
Intravitreal triamcinolone acetonide for treatment of acute nonarteritic anterior ischemic optic neuropathy.
Graefes Arch Clin Exp Ophthalmol.
2006; May 4;
, (Epub ahead of print)
-
107
Sadda S R, Nee M, Miller N R, Biousse V, Newman N J, Kouzis A.
Clinical spectrum of posterior ischemic optic neuropathy.
Am J Ophthalmol.
2001;
132
743-750
-
108
Hayreh S S.
Posterior ischaemic optic neuropathy: clinical features, pathogenesis, and management.
Eye.
2004;
18
1188-1206
-
109
Hayreh S S.
Posterior ischemic optic neuropathy.
Ophthalmologica.
1981;
182
29-41
-
110
Alexandrakis G, Lam B L.
Bilateral posterior ischemic optic neuropathy after spinal surgery.
Am J Ophthalmol.
1999;
127
354-355
-
111
Marks S C, Jaques D A, Hirata R M, Saunders Jr J R.
Blindness following bilateral radical neck dissection.
Head Neck.
1990;
12
342-345
-
112
Rizzo III J F, Lessell S.
Posterior ischemic optic neuropathy during general surgery.
Am J Ophthalmol.
1987;
103
808-811
John B KerrisonM.D.
Retina and Neuro-Ophthalmology Division, Charleston Neuroscience Institute
3531 Mary Ader Drive, Charleston, SC 29414-5741