Acute optic neuropathy, a common ophthalmologic emergency
A 62-year-old Asian male patient presented to the emergency with a 5-day history of sudden vision impairment. The patient told the doctors that he woke up with sudden partial vision loss of the left eye and he was completely fine the evening before. He could not see anything clearly in his entire field and described the impairment as “severe blurriness”. Doctors diagnosed him with Nonarteritic, anterior ischemic optic neuropathy.
However, he did not seek any medical care for it, hoping that it would improve with time. His medical history did not reveal any similar incidences from the past. The patient was currently on lisinopril 20 mg at bedtime for hypertension and metformin 1 g daily for type 2 diabetes. He was taking no other medications and denied any past psychiatric illnesses. His surgical history revealed that he underwent an appendectomy at the age of 28. Whereas never smoked, abused alcohol or used illicit drugs. All of his lab results were insignificant, also.
Physical examination showed normal vitals with intact extraocular muscles.
The patient’s intraocular pressure was also measured to be in normal limits. Doctors performed a fundoscopic examination of the affected eye which showed a small, hyperemic disc with indistinguishable borders. The remainder of his physical and neurological examinations were also insignificant.
The patient was then referred to ophthalmology. Based on the clinical findings, doctors diagnosed the patient nonarteritic, anterior ischemic optic neuropathy. Since the patient did not want to opt for the only available treatment of intraoptic injections, he was given the option of enrolling in an ongoing trial. Patients with the disease generally present with diffuse optic disc edema with superficial hemorrhages. Predisposing factors include cardiovascular disease, diabetes, hyperlipidemia, ischemic heart disease, hypertension, nocturnal hypotension, sleep apnea, stroke and tobacco use.
References
Nonarteritic, Anterior Ischemic Optic Neuropathy: A Case Study https://www.clinicaladvisor.com/home/topics/neurology-information-center/nonarteritic-anterior-ischemic-optic-neuropathy-case-study/2/
