Atlas Entry - Non-arteritic anterior ischemic optic neuropathy (NAION)

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Ophthalmology and Visual Sciences

Non-arteritic anterior ischemic optic neuropathy (NAION)

Non-arteritic anterior ischemic optic neuropathy (NAION)

Category(ies): Neuro-ophthalmology

Contributor: Noor-Us-Sabah Ahmad, MD; Salma Dawoud, MD

March 22, 2023

45-year-old man who awoke with left sided inferior visual field loss.

fundus OS NAION — The right eye showed a structurally congested optic disc without edema or pallor. (Fig. 1)

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fundus OS NAION — Funduscopic examination showed optic disc edema in the left eye that was more prominent inferiorly along with RNFL hemorrhages. (Fig. 2)

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fundus OS NAION 6 months later — Six months later, he presented with decrease in vision in the right eye with right optic disc edema involving the superior part of the optic disc. (Fig. 3)

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fundus OS NAION 6 months later — Left eye at that time showed superior segmental optic disc pallor. (Fig. 4)

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superior segmental optic disc (asterisk) pallor and loss of the RNFL bundle superiorly — Fig. 5

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superior segmental optic disc (asterisk) pallor and loss of the RNFL bundle superiorly — Fig. 6

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Seventeen months after first presentation, his visual acuities were 20/15-1 OD and 20/50-2 OS. Funduscopic examination showed superior segmental optic disc (asterisk) pallor and loss of the RNFL bundle superiorly (black arrow) versus normal RNFL inferiorly (green arrow) in both eyes. (Fig. 5 and 6)

OCT of the optic nerves showed bilateral superior RNFL bundle loss — OCT of the optic nerves showed bilateral superior RNFL bundle loss corresponding with the above photo. (Fig. 7)

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GCL analysis demonstrates superior altitudinal — GCL analysis demonstrates superior altitudinal GCL loss. (Fig. 8)

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Goldmann visual fields obtained seventeen months after first presentation - OD — Goldmann visual fields obtained seventeen months after first presentation showed an inferior altitudinal defect in the right eye with generalized depression. (Fig. 9)

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Goldmann visual fields obtained seventeen months after first presentation - OS — Testing of the left eye showed inferior constriction with cecocentral depression. (Fig. 10)

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Contributor: Andrew Doan, MD, PhD and Sohan S. Hayreh, MD, PhD

This patient experienced bilateral vision loss on awakening. She had bilateral optic nerve swelling with the visual fields below.

goldman visual field — Note how the visual field defect respects the horizontal raphe distribution of the nerve fiber layer.

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Fundus photographs of right eye of a diabetic patient with non-arteritic AION showing — Fundus photographs of right eye of a diabetic patient with non-arteritic AION showing. During early stages optic disc edema involving the superior temporal part of the optic disc and prominent vessels in that region.

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During later stages: pale color (atrophy) in the upper half of the optic disc - more marked in the temporal than the nasal part, and spontaneous resolution of the prominent blood vessels on the optic disc — During later stages: pale color (atrophy) in the upper half of the optic disc - more marked in the temporal than the nasal part, and spontaneous resolution of the prominent blood vessels on the optic disc.

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Ophthalmic Atlas Images by EyeRounds.org, The University of Iowa are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

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Roy J. and Lucille A. Carver College of Medicine
Department of Ophthalmology and Visual Sciences
200 Hawkins Drive
Iowa City, IA 52242

University of Iowa
Roy J. and Lucille A. Carver College of Medicine
Department of Ophthalmology and Visual Sciences
200 Hawkins Drive
Iowa City, IA 52242

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