The diagnosis of ischaemic optic neuropathy is based on the visual symptoms and signs. The investigations indicated in all cases are a complete blood count, ESR, fibrinogen level, and carotid non-invasive studies, including transorbital Doppler evaluation. A cardiac evaluation, including two-dimensional transthoracic echocardiogram, Holter monitor, and magnetic resonance angiography of the head and neck and/or CT angiography are indicated when ischaemic optic neuropathy is thought to be embolic. In non-arteritic ischaemic optic neuropathy tests should also be directed towards the detection of associated systemic vascular disease such as hypertension, diabetes mellitus, and hyperlipidaemia or a variety of coagulopathies, for example, those caused by decreased concentrations of protein C, protein S, or antithrombin III.91 In giant cell arteritis-associated ischaemic optic neuropathy with a high ESR and fibrinogen level, a temporal artery biopsy is mandatory.

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