Anterior Ischaemic Optic Neuropathy

Question 1

What is Anterior Ischaemic Optic Neuropathy AION?

Answer 1

Ischaemia of anterior optic nerve head

Occlusion of the posterior ciliary arteries

Question 2

What are the 2 types of AION?

Answer 2

Arteritic (AAION)

Non-arteritic (NA-AION)

Question 3

What is AAION associated with?

Answer 3

Temporal arteritis

Question 4

What is Temporal arteritis

Answer 4

Giant cell arteritis (GCA)- Inflammation of medium and large arteries

Question 5

What are the symptoms of Temporal arteritis?

Answer 5

Headache
normally constant
gradual onset to a diffuse severe aching
superficial scalp tenderness - temporal
worse at night and in the cold

General malaise, weight loss, jaw claudication, amaurosis fugax
Polymyalgia rheumatica

Question 6

What age group is AAION common in?

Answer 6

70’s - 80’s

Question 7

What are the signs of AAION?

Answer 7

Profound loss of vision
NLP, LP or HM

• Pale oedematous optic nerve head
• Splinter haemorrhages
• RAPD

Question 8

What age group is NA-AION common in?

Answer 8

60’s

Question 9

What are the symptoms of NA-AION?

Answer 9

Sudden loss of vision-Mild to severe, usually on waking, vision loss either static or progressive

20% lose vision in other eye within 5 years

Associated with hypertension, diabetes

Question 10

What are the signs of NA-AION?

Answer 10

• Oedematous optic nerve head- diffuse or segmental, hyperaemic or pale
• Visual field loss-usually altitudinal

Contralateral eye-small disc, small or absent cup, subsequent optic atrophy

33% left with near normal V/A

Question 11

How do you manage AION?

Answer 11

Assume arteritic until proven otherwise and send to A&E

Question 12

How do you investigate AION?

Answer 12

Dilate fundus exam

VA,pupils,Colour vision, VFs, IOPs

Question 13

What does ophthalmologist do?

Answer 13

Blood tests, temporal artery biopsy, MRI scan, asprin

Question 14

How is A-AION treated

Answer 14

If arteritic high doses of systemic steroids for years