Definition of Ischemic Optic Neuropathy

Damage to the optic nerve resulting from insufficient blood supply, sometimes called “stroke” of the optic nerve. Ischemic optic neuropathy is occurs most commonly in people over age 55 and causes mild to complete vision impairment.

There are two forms: arteritic, associated with giant-cell arteritis (an inflammatory disorder of the arteries that typically affects the temporal arteries) and nonarteritic, which correlates with cardiovascular disease (cvd) such as hypertension (high blood pressure) and atherosclerosis.

Other conditions associated with the nonarteritic form include diabetes, hypotension (low blood pressure), and rheumatoid arthritis.

Symptoms of Ischemic Optic Neuropathy and Diagnosis

Vision impairment due to ischemic optic neuropathy comes on suddenly. In a characteristic pattern, a person wakes up in the morning with noticeable loss of visual acuity and visual field. This may continue for several days, improving as the day goes on, though in short order becomes permanent.

The diagnostic path begins with ophthalmoscopy and slit lamp examination to visualize the optic disk (portion of the optic nerve that attaches to the retina), which appears pale and swollen. Diagnosis of giant cell arteritis by temporal artery biopsy confirms the diagnosis of the arteritic form of ischemic optic neuropathy.

Doctors arrive at the diagnosis of the nonarteritic form on the basis of symptoms and ruling out other causes.


Treatment for arteritic ischemic optic neuropathy is corticosteroid medications to reduce the inflammation. Vision loss, however, is irreversible. There are no effective treatments for the nonarteritic form, which does not appear to improve with corticosteroids.

Lifestyle modifications such as smoking cessation improve circulation in general with the presumption that such improvement also affects optic structures. Aspirin therapy, such as prescribed as a prophylactic measure for heart attack and stroke, may have a preventive effect with the arteritic form. It is especially important to manage underlying health conditions that affect circulation, such as hypertension and diabetes.

When the ischemic optic neuropathy affects only one eye, the person can make adaptations and adjustments to accommodate the vision impairment that do not necessarily require substantial changes in lifestyle.

Most people can still read, work, and perform other functions of daily living with visual acuity in only one eye. Ischemic optic neuropathy that involves both eyes can significantly affect lifestyle.


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