Arteritic Anterior Ischemic Optic Neuropathy Definition

An acute disruption of the blood supply to the optic disk due to inflammation of medium-sized and small arterial branches.

Epidemiology: The annual incidence is approximately three cases per 100000.The disorder occurs almost exclusively after the age of 60. Women are affected slightly more often than men, accounting for 55% of all cases. Fifty per cent of all patients suffer from ocular involvement within a few days up to approximately three months of the onset of the disorder.

Etiology: Giant cell arteritis is a frequently bilateral granulomatous vasculitis that primarily affects the medium-sized and small arteries. Common sites include the temporal arteries, ophthalmic artery, short posterior ciliary arteries, central retinal artery, and the proximal portion of the vertebral arteries, which may be affected in varying combinations.

Symptoms: Patients report sudden unilateral blindness or severe visual impairment. Other symptoms include headaches, painful scalp in the region of the temporal arteries, tenderness to palpation in the region of the temporal arteries, pain while chewing (a characteristic sign), weight loss, reduced general health and exercise tolerance. Patients may have a history of amaurosis fugax or polymyalgia rheumatica.

Diagnostic considerations: The ophthalmoscopic findings are the same as in arteriosclerotic AION (see Fig. 13.12a). Other findings include a significantly increased erythrocyte sedimentation rate (precipitous sedimentation is the most important hematologic finding), an increased level of C-reactive protein, leukocytosis, and iron-deficiency anemia.

Erythrocyte sedimentation rate should be measured in every patient presenting with anterior ischemic optic neuropathy.

The temporal arteries are prominent (Fig. 13.13), painful to palpation, and have no pulse. The diagnosis is confirmed by a biopsy of the temporal artery. Because of the segmental pattern of vascular involvement, negative histologic findings cannot exclude giant cell arteritis.

H Giant cell arteritis should be considered in every patient presenting with anterior ischemic optic neuropathy.

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