Anterior Ischemic Optic Neuropathy

The clinical characteristics of ischemic optic neuropathy include age at onset generally older than 60 years, painless vision loss, and afferent pupillary defect (Marcus Gunn pupil). These patients also usually have a visual field abnormality. Examination of the optic disc reveals edema in almost all cases. Pathology appears to be related to a diseased ciliary circulation. It is generally difficult to determine whether the disc edema will result in a mild peripheral (side) visual field defect and good visual acuity, or reduced central acuity and a significant visual field defect. Giant cell arteritis must be ruled out in these patients. A general physical examination and associated blood work are indicated. No treatment prevents the progression of ischemic optic neuropathy, including steroids and anticoagulants.

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