Anterior ischemic optic neuropathy

If you find that the elderly in your family suddenly can't see clearly or has temporary blindness, don't assume that it is a natural deterioration of visual function caused by old age. Be sure to take the elderly to the hospital's ophthalmology department for a comprehensive examination in time. Because these symptoms may be caused by anterior ischemic optic neuropathy. If not treated promptly, optic nerve atrophy may occur and eventually lead to blindness.

1. Concept

Hemorrhagic optic neuropathy is a general term for a class of common optic nerve diseases that seriously threaten vision and even cause blindness. Clinically, it is divided into two types: anterior segment ischemic optic neuropathy and posterior segment ischemic optic neuropathy. The main type in the Chinese population is non-arteritic anterior ischemic optic neuropathy. Anterior ischemic optic neuropathy is also called ischemic disc disease. The small branches of the posterior ciliary blood vessels that supply the anterior and lamina cribrosa areas of the optic disc become ischemic, causing local infarction in the supply area. It is more common in the elderly.

2. Type

1. Non-arteritic: also known as arteriosclerosis. It is more common in patients aged 40-60 years old, and may have risk factors such as diabetes, hypertension, and hyperlipidemia. Nocturnal hypotension may play a role in this disorder, particularly in patients taking medications for hypertension.

2. Arteritis: less common than the former, mainly ischemic optic neuropathy caused by temporal arteritis or giant cell arteritis, more common in people aged 70-80 years old. Its visual impairment and optic disc edema are more obvious than the former.

3. Causes

1. Vasculitis: giant cell arteritis, polyarteritis nodosa, systemic lupus erythematosus, Buergers disease, allergic vasculitis, post-viral vasculitis, post-immunization, syphilis, and radiation necrosis.

2. Systemic vascular disease, hypertension, atherosclerosis, diabetes, migraine, large arteritis, and carotid artery obstructive lesions.

3. Blood diseases, polycythemia vera, sickle cell disease, acute hypotension (shock), G-6-PD deficiency.

4. Hypotension and glaucoma after cataract surgery.

Symptoms

1. Sudden visual loss, optic disc edema and characteristic visual field defects. Unilateral visual acuity and visual field loss in varying degrees and the visual field defect is consistent with optic neuropathy, optic disc edema in the acute phase, followed by optic disc atrophy, relative afferent pupillary defect in unilateral disease or binocular asymmetry.

2. Transient vision loss. In the early stage, the optic disc is slightly swollen and appears light red, but more often it is grayish white, and there is visual field loss. There may be a small number of nerve fiber layer hemorrhages around the optic disc, which disappear on their own within 1 to 2 weeks. Flocculent exudate may also be seen.

3. Optic nerve atrophy occurs after 1-2 months and may be cup-shaped, such as optic nerve atrophy in glaucomatous eyes.

1. People with hypertension or arteriosclerosis may show corresponding changes of retinal arteriosclerosis.

5. Diagnosis

1. Sudden decrease in vision, typical visual field loss;

2. Headaches and eye marks, especially due to temporal arteritis;

3. Fundus fluorescein angiography showed low fluorescence or slow or no fluorescence filling of the optic disc; the intraocular pressure recovery rate of the eyeball compression test was significantly low.

5. Changes in the fundus: In the early stage, part or all of the optic disc becomes lighter in color and the edges become blurred. There is mild to moderate edema. There may be a small amount of hemorrhage in the optic disc and nearby retina. In the late stage, the optic disc edema subsides, leaving part or all of the optic disc pale and the retinal blood vessels thinning.

6. Visual field changes: It may be quadrantanopia or hemianopia, but it is not bounded by the horizontal or vertical midline. It is an arc-shaped visual field defect connected to the physiological blind spot.

6. Treatment

1. Early use of corticosteroids can reduce exudation and edema caused by ischemia.

2. Drugs that lower intraocular pressure.

3. Use vasodilators and multivitamins.

VII. Prevention

Pay attention to eye hygiene, strengthen exercise, and eat a light diet to avoid blockage and ischemia of eye blood vessels.