Acute, Painless Monocular Vision Loss: Non-arteritic Ischemic Optic Neuropathy Associated With Untreated Obstructive Sleep Apnea, Uncontrolled Type 2 Diabetes Mellitus, Essential Hypertension, and Hyperlipidemia: A Case Report

Abstract

Non-arteritic ischemic optic neuropathy (NAION) is a common cause of acute, painless monocular vision loss in adults older than 50. NAION is a diagnosis of exclusion established once arteritic disease and other etiologies of acute vision loss have been ruled out. Clinicians need to distinguish NAION from arteritic ischemic optic neuropathy (AION) since failing to appropriately treat patients presenting with AION results in an inferior prognosis. NAION is often associated with risk factors like obstructive sleep apnea, atherosclerosis, diabetes mellitus, hypertension, hyperlipidemia, smoking, and phosphodiesterase-5 inhibitors. Clinicians need to address these risk factors to help prevent the development of NAION in their patients. Here, we present the case of a 63-year-old Caucasian male who presented with acute, painless monocular vision loss.

Keywords: aion; arteritic ischemic optic neuropathy; diabetes mellitus; giant cell arteritis; hypertension; naion; non-arteritic ischemic optic neuropathy; obstructive sleep apnea.

Figure 1. MRI of the orbits with contrast showing subtle uniform enhancement of the left and right optic nerves immediately behind the globes (arrows)