Arteritic anterior ischemic optic neuropathy

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Arteritic anterior ischemic optic neuropathy
Specialty Ophthalmology, rheumatology

Arteritic anterior ischemic optic neuropathy (arteritic AION, A-AION or AAION) is vision loss that occurs in giant cell arteritis (also known as temporal arteritis). Temporal arteritis is an inflammatory disease of medium-sized blood vessels that happens especially with advancing age. AAION occurs in about 15-20 percent of patients with temporal arteritis. Damage to the blood vessels supplying the optic nerves leads to insufficient blood supply (ischemia) to the nerve and subsequent optic nerve fiber death. Most cases of AAION result in nearly complete vision loss first to one eye. If the temporal arteritis is left untreated, the affected eye will likely suffer vision loss as well within 1–2 weeks. Arteritic AION (AAION) falls under the general category of anterior ischemic optic neuropathy (AION), which also includes non-arteritic AION (NAION). AAION is considered an eye emergency, immediate treatment is essential to rescue remaining vision. [1]

Contents

Symptoms

Sudden visual loss is the most common symptom in AAION, [1] and is most often accompanied by other symptoms of temporal arteritis: such as jaw claudication, scalp tenderness, unintentional weight loss, fatigue, myalgias and loss of appetite. [1] A related disease called polymyalgia rheumatica has a 15 percent incidence of giant cell arteritis.

Cause

AAION is almost always caused by temporal arteritis (also known as giant cell arteritis). [1] In rare cases, AAION may be caused by other types of vasculitis, such as polyarteritis nodosa, systemic lupus erythematosus and herpes zoster. [1] In AAION, the posterior ciliary artery becomes inflamed which results in a thrombotic occlusion of the main blood supply to the optic nerve head with a risk of visual loss in the affected eye or eyes. [1]

Diagnosis

Diagnosis is primarily made by examination by an ophthalmologist. [1] The diagnosis may be suspected in people with visual loss or amaurosis fugax. [1] AAION occurs in elderly and late middle-aged people. [1] Certain blood tests are usually elevated which may help identify AAION as part of temporal arteritis: erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). [1]

Treatment

AAION requires urgent intervention with a very long course of corticosteroids to prevent further damage. [1]

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<span class="mw-page-title-main">Giant cell arteritis</span> Inflammatory disease of large blood vessels

Giant cell arteritis (GCA), also called temporal arteritis, is an inflammatory autoimmune disease of large blood vessels. Symptoms may include headache, pain over the temples, flu-like symptoms, double vision, and difficulty opening the mouth. Complications can include blockage of the artery to the eye with resulting blindness, as well as aortic dissection, and aortic aneurysm. GCA is frequently associated with polymyalgia rheumatica. It can be confirmed by biopsy of the temporal artery in about 90% of people.

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Anterior ischemic optic neuropathy (AION) is a medical condition involving loss of vision caused by damage to the anterior portion of the optic nerve as a result of insufficient blood supply (ischemia). This form of ischemic optic neuropathy is generally categorized as two types: arteritic AION, in which the loss of vision is the result of an inflammatory disease of arteries in the head called temporal arteritis, and non-arteritic AION, which is due to non-inflammatory disease of small blood vessels. It is in contrast to posterior ischemic optic neuropathy, which affects the retrobulbar portion of the optic nerve.

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Non-arteritic anterior ischemic optic neuropathy (NAION) is a medical condition characterized by loss of vision caused by damage to the optic nerve as a result of ischemia, or insufficient blood supply. The key symptom of NAION is optic disc swelling, which typically resolves within 2 months, but often leads to optic atrophy. The likelihood of vision improvement after developing this condition is low.

References

  1. 1 2 3 4 5 6 7 8 9 10 11 Hayreh, Sohan Singh (2011). "Management of ischemic optic neuropathies". Indian Journal of Ophthalmology. 59 (2): 123–136. doi: 10.4103/0301-4738.77024 . ISSN   0301-4738. PMC   3116541 . PMID   21350282.