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Anterior Ischemic Optic Neuropathy (AION)

Sudden painless vision loss caused by impaired blood flow to the optic nerve head.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Göz Hastalıkları department. Book Appointment →

What is Anterior Ischemic Optic Neuropathy (AION)?

Anterior ischemic optic neuropathy (AION) results from compromised blood flow in the short posterior ciliary arteries supplying the optic nerve head. It is divided into non-arteritic (NAION) and arteritic (AAION) forms.

NAION accounts for about 95% of cases and is associated with vasculopathic risk factors (hypertension, diabetes, hyperlipidemia, sleep apnea, nocturnal hypotension, and a small crowded optic disc cup-to-disc ratio). AAION is caused by giant cell arteritis (temporal arteritis) and is a medical emergency.

Distinguishing the two is critical: erythrocyte sedimentation rate, C-reactive protein, temporal artery biopsy, and the presence of jaw claudication, scalp tenderness, polymyalgia rheumatica or constitutional symptoms suggest AAION.

Symptoms

Sudden painless monocular vision loss on awakening
Altitudinal visual field defect (often inferior)
Optic disc swelling with hemorrhages
Relative afferent pupillary defect
In AAION: jaw claudication, headache, scalp tenderness, weight loss
Decreased color vision
Counting fingers or worse acuity in severe cases

Risk Factors

Age over 50 years
Hypertension and diabetes mellitus
Hyperlipidemia
Obstructive sleep apnea
Nocturnal hypotension or use of antihypertensives at night
Small crowded optic disc ("disc at risk")
Use of phosphodiesterase-5 inhibitors (controversial)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Sudden painless loss of vision in one eye
  • New altitudinal visual field defect
  • Headache with scalp or jaw symptoms
  • Polymyalgia symptoms over age 50
  • Vision loss with constitutional symptoms
  • Suspected fellow eye involvement

Treatment Methods

01
Urgent ESR, CRP and consideration of temporal artery biopsy if AAION suspected
02
Immediate high-dose corticosteroids (IV methylprednisolone) for AAION
03
Long-term oral steroids and tocilizumab in giant cell arteritis
04
Aspirin and vasculopathic risk factor control in NAION
05
Avoidance of nocturnal antihypertensive dosing
06
CPAP therapy for obstructive sleep apnea
07
Low-vision rehabilitation

Which Department to Visit?

You can visit our Göz Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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