Ischemic optic neuropathy

Howard D Pomeranz MD PhD (Dr. Pomeranz of Hofstra North Shore-LIJ School of Medicine and North Shore-LIJ Health System has no relevant financial relationships to disclose.)
Jonathan D Trobe MD, editor. (Dr. Trobe of the University of Michigan has no relevant financial relationships to disclose.)
Originally released April 26, 1999; last updated March 31, 2015; expires March 31, 2018
Notice: This article has expired and is therefore not available for CME credit.

This article includes discussion of ischemic optic neuropathy, AION, anterior ischemic optic neuropathy, ischemic optic neuropathy (anterior), ischemic papillitis, NAION, nonarteritic anterior ischemic optic neuropathy, PION, posterior ischemic optic neuropathy, arteritic anterior ischemic optic neuropathy, progressive nonarteritic anterior ischemic optic neuropathy, and static nonarteritic anterior ischemic optic neuropathy. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.


Ischemic optic neuropathy is a common cause of sudden visual loss in patients over 50 years of age. The most common form of this condition, called nonarteritic anterior ischemic optic neuropathy, occurs in the context of “vasculopathic” risk factors, particularly diabetes, hypertension, or hypercholesterolemia. In some patients, giant cell arteritis is the cause ischemic optic neuropathy (arteritic ischemic optic neuropathy). Arteritic ischemic optic neuropathy is a true visual emergency because the second eye may become involved within days if giant cell arteritis is not treated promptly. Less commonly, the ischemic optic neuropathy may be posterior. Rare causes of non-arteritic ischemic optic neuropathy include associations with surgery (cataract surgery, spinal surgery, cardiac, and transplant surgeries), sleep apnea, and phosphodiesterase inhibitors.

Historical note and terminology

In 1966 Miller and Smith described a syndrome of acute, monocular, painless visual loss, afferent pupillary defect, and optic disc edema, terming it, ischemic optic neuropathy (Miller and Smith 1966). The term ischemic optic neuropathy identified the non-inflammatory nature of the disorder, which previously had been variously named vascular pseudopapillitis, arteriosclerotic papillitis, and ischemic papillitis. Hayreh subsequently added the keyword “anterior,” to denote those cases of ischemic optic neuropathy that included optic disc edema in the acute phase (non-arteritic anterior ischemic optic neuropathy), differentiating them from the rarer posterior ischemic optic neuropathy, in which the disc appearance is initially normal (Hayreh 1974a).

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