Ischaemic Optic Neuropathy

Some elderly patients complaining of visual loss in one eye are found to have a pale swollen optic disc and sometimes evidence of branch retinal artery occlusion, giving an altitudinal defect of the visual field. This appearance should suggest the possibility of temporal arteritis and an erythrocyte sedimentation rate (ESR) and a temporal artery biopsy should be considered as urgent investigations (Figure 21.13).

However, there is a group known as "non-arteritic" or idiopathic anterior ischaemic optic neuropathy (AION), which occurs in otherwise healthy individuals between 45 and 65 years of age. About one-third of these patients develop bilateral disease. In these patients, retinal arterial occlusion is absent. There is no known treatment for nonarteritic AION but giant cell arteritis needs to be excluded.

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