Non-Arteritic Anterior Ischaemic Optic Neuropathy - Myths and Misconceptions: Experience from a Tertiary Care Centre in North India

Abstract

We prospectively evaluated 22 consecutive patients (24 eyes) suffering from non-arteritic anterior ischaemic optic neuropathy (NAION) at a tertiary care centre in Northern India. The mean age was 51.7 years. Visual loss on awakening was noticed only in three (12.5%) eyes. Six (27.3%) patients had headache while three (9.7%) patients had retro-orbital pain at the onset of visual loss. Peripapillary haemorrhages were seen in two (8.3%) eyes. At follow up, only one eye showed improvement in visual acuity. The results of our study suggest that NAION may not always present with the classic clinical picture. Accordingly, a high index of suspicion remains the key to correct diagnosis.

Keywords: Non-arteritic anterior ischaemic optic neuropathy; North India; misconceptions; myths.

Figure 1.

NAION of the left eye of five days duration in a 47-year-old woman with diabetes mellitus. (a) Note optic disc oedema at presentation giving way to optic atrophy (b) at follow up. (c) Fluorescein angiography revealed optic disc hypoperfusion in the acute phase and (d) showed diffuse leakage of dye from the optic disc in the late phase.

Figure 2.

67-year-old woman with acute diminution of vision in the right eye and a past history of a similar event in the left eye. Top panel: Fundus photograph showing optic disc oedema with peripapillary haemorrhages in the right eye and optic atrophy in the left eye. Bottom panel: Visual field examination showing a diffuse defect (superior>inferior) in the right eye and an inferior altitudinal field defect in the left eye.