Introduction · Ocular Manifestations · Diagnosis
Posterior Ischemic Optic Neuropathy (PION) is an acute optic neuropathy due to ischemia in the posterior (retrobulbar) portion of the optic nerve.
Apr 3, 2015 · Posterior ischemic optic neuropathy (PION) is a potentially devastating condition characterized by acute, painless vision loss in one or both ...
64-year-old male admitted to the intensive care unit following a spinal surgery who reports profoundly decreased vision in both eyes upon waking the following morning. His corrective lenses did not improve his vision.
Abstract · Introduction · Methods · Results
Perioperative posterior ischemic optic neuropathy (PION) is a rare but devastating condition. Visual impairment is commonly bilateral, profound, and irreversible. The most frequently associated triggering events are spine surgeries, other orthopedic surgeries, ...
Purpose To investigate and present a comprehensive account of the clinical features, pathogenesis, and management of posterior ischaemic optic neuropathy ...
Purpose To investigate and present a comprehensive account of the clinical features, pathogenesis, and management of posterior ischaemic optic neuropathy (PION). Methods This retrospective study is based on 53 consecutive eyes of 42 patients with PION seen in my clinic since 1973, who fulfilled the inclusion criteria. They were systematically evaluated, treated, and followed by me. All patients had initially detailed ophthalmic evaluation of the anterior and posterior segments, including visual field with Goldmann perimeter and fluorescein fundus angiography. All patients aged 50 years and older were also investigated for giant cell arteritis (GCA). Every attempt was made to rule out other causes of visual loss. Follow-up evaluation was similar to the initial evaluation except angiography. Aetiologically, PION can be divided into three types: arteritic due to GCA, nonarteritic not due to GCA, and surgical following a surgical procedure. Steroid therapy was given to only those nonarteritic PION patients who opted to try that, but was given to all arteritic PION patients. Results PION was nonarteritic in 28 patients (35 eyes), arteritic in 12 (14 eyes), and surgical in three (four eyes). Visual acuity varied between 20/20 and no light perception—it was count fingers or less in 19 of 35 eyes with nonarteritic PION, four of 14 in arteritic, and all four with surgical PION. The most common visual field defect was central visual loss, alone or in combination with other types of visual field defects. Initially, optic disc and fundus showed no abnormality but the disc usually developed pallor in about 6–8 weeks. Aggressive treatment with high-dose systemic steroid during the very early stages of nonarteritic PION produced significant improvement of visual acuity as well as visual fields, but not so in arteritic or surgical PION. However, some spontaneous visual improvement also occurred in some untreated nonarteritic PION cases. Conclusions PION is a distinct clinical entity but should be diagnosed only after exclusion of all other causes of visual loss. In all patients older than 50, GCA must be ruled out. There is usually marked visual loss, with central field defect being the most common. The study suggests that high-dose steroid therapy in nonarteritic PION, soon after the onset of visual loss, resulted in significant visual improvement compared to the untreated cases, but not in arteritic and surgical PION.
Oct 9, 2010 · Patients with both anterior and posterior ischemic optic neuropathy present with acute vision loss in one or both eyes that is not associated ...
Ischemic optic neuropathy is a major cause of blindness or significantly impaired vision, and there are few definitive answers regarding its cause, clinical features and treatment.
Nov 2, 2022 · Introduction. Posterior ischemic optic neuropathy (PION) is a rare optic neuropathy of vascular origin involving the retrobulbar optic nerve and ...
An 80-year-old female with a history of diabetes mellitus (DM) and hypertension presented with sudden onset of sequential bilateral visual loss. The best visual acuity was light perception in the right eye and finger counting in the left eye, however, bilateral fundus did not reveal optic disc edema. Diffusion-weighted magnetic resonance imaging (MRI) of the brain revealed acute embolic stroke and diffusion restriction in the posterior portion of both optic nerves. The 24-h Holter monitor showed persistent atrial fibrillation (AF) with rapid ventricular response. The presence of painless and severe visual loss at onset unaccompanied by optic disc edema in the patient with newly detected uncontrolled AF and multiple embolic infarctions favored a diagnosis of non-arteritic posterior ischemic optic neuropathy (PION). The current case contributes to better understanding of PION pathophysiology and associated risk factors, indicating a possible relationship between non-arteritic PION and uncontrolled AF and embolic cerebral infarction.
Ischemic optic neuropathy is the sudden loss of vision due to an interruption in blood flow to the optic nerve.
PION results from hypoxia of the optic nerve which is a product of the oxygen-carrying capacity in the blood and the amount of blood flow to the optic nerve.
Mar 24, 2023 · Posterior ischemic optic neuropathy (PION) is caused by acute ischemia affecting the posterior part of the optic nerve and can be classified ...
Abstract. Posterior ischemic optic neuropathy (PION), a relatively rare condition, is diagnosed primarily based on the clinical presentation of sudden visual impairment, an optic nerve-related visual field defect, and an initial normal optic disc that corresponds to its pathology of acute ischemia. Among its etiologies, nonarteritic PION is one of the most common causes. Studies on cases of PION associated with herpes zoster ophthalmicus (HZO) are limited, and the diagnosis was made based on the appearance of visual symptoms shortly following rashes. We describe a 64-year-old Asian woman with sudden painless visual loss in the upper half visual field of the left eye 6 weeks after ipsilateral HZO. Within a week, her left vision progressed to total visual loss. Initial examination revealed a near-total visual defect and a normal appearance of the optic disc in the left eye. Laboratory and imaging studies excluded the compressive, infiltrative, or inflammatory etiologies of the left optic nerve. Considering the temporal relationship between the skin rash and visual loss, HZO was the most likely cause of the nonarteritic PION. The patient was given a short course of oral valaciclovir and aspirin. At 6 weeks after the visual loss, an examination revealed stationary visual acuity and visual field defect in the left eye with a pale optic disc, and a retinal nerve fiber loss in the left eye. Compared with previous studies, our case demonstrated a delayed presentation of nonarteritic PION following HZO and broadened the scope of herpes zoster optic neuropathy.
Mar 31, 2010 · 14 cases of posterior ischemic optic neuropathy (PION) were clinically analyzed, in whom we excluded known etiologies of optic nerve ...
Abstract. 14 cases of posterior ischemic optic neuropathy (PION) were clinically analyzed, in whom we excluded known etiologies of optic nerve disturbances and confirmed the decreased blood supply to the posterior portion of the optic nerve. On the basis of our clinical findings, we have proposed the following criteria for the diagnosis of idiopathic PION: (1) sudden onset of unilateral visual disturbance in older patients; (2) normal optic disc, subsequently developing simple optic atrophy; (3) hypertensive and arteriosclerotic changes in the retinal vessels; (4) varying degrees of impaired vision, variable visual field defects; (5) associated systemic disease such as hypertension, diabetes mellitus, hyperlipemia, hypotension, etc.; (6) exclusion of other demonstrable causes of optic nerve disturbances, and (7) confirmation of abnormal hemodynamics in the posterior portion of the optic nerve by carotid angiography, ophthalmodynamography, ophthalmodynamometry and fluorescein fundus angiography.
Perioperative posterior ischemic optic neuropathy (PION) is a rare but devastating condition. Visual impairment is commonly bilateral, profound, and irreversible. The most frequently associated triggering events are spine surgeries, other orthopedic surgeries, cardiac bypass surgeries, and radical neck dissection.What is the most common cause of ischemic optic neuropathy? ›
Arteritic anterior ischemic optic neuropathy (AAION): It occurs in patients age more than 70 years. It is caused by inflammatory and thrombotic occlusion of short posterior ciliary arteries. It is associated with systemic vasculitis, giant cell arteritis (GCA) being the most common cause.What is the prognosis for ischemic optic neuropathy? ›
ION can affect your central (detail) vision or side (peripheral) vision—or both. Because a damaged optic nerve cannot be fixed, any vision loss from ION is usually permanent. Usually, people with severe ION still have some peripheral vision.How serious is ischemic optic neuropathy? ›
The inflammation is due to a condition called giant-cell arteritis or temporal arteritis, which is potentially life-threatening and can cause massive vision loss.What is the treatment for ischemic optic neuropathy? ›
Treatment of Ischemic Optic Neuropathy
In people with arteritic ischemic optic neuropathy caused by giant cell arteritis, high doses of corticosteroids are given by mouth and/or vein as soon as possible to prevent loss of vision in the other eye.
Both your central or detailed vision and your peripheral side vision can be affected by ischemic optic neuropathy. An optic nerve that has an injury cannot be fixed, so usually, if there is vision loss from ischemic optic neuropathy, it is permanent.Is ischemic optic neuropathy considered a stroke? ›
An eye stroke, or anterior ischemic optic neuropathy, is a dangerous and potentially debilitating condition that occurs from a lack of sufficient blood flow to the tissues located in the front part of the optic nerve.Is ischemic optic neuropathy progressive? ›
1 Following the initial insult, most patients remain stable or may notice slight improvement in their vision. However, a minority of patients suffer from a progressive form of NAION and their vision deteriorates further after the initial examination.Which drug causes optic neuropathy? ›
Causes of toxic optic neuropathy include chemicals and drugs, such as methanol, ethylene glycol, ethambutol, isoniazid, digitalis, cimetidine, vincristine, cyclosporine, toluene, sildenafil, and amiodarone.How fast does optic neuropathy progress? ›
An episode of Optic Neuritis typically begins with eye pain, especially with eye movements. Within a few days, patients will notice blurred vision in the affected eye. Often this appears like a “thumb-print” or smudge that blurs the vision. Within a week, this may progress to darkening of part of the visual field.
Patients with severe vision loss in only one eye may be able to continue to drive. In most cases of a bilateral AION, the combination of visual acuity loss, visual field impairment and loss of contrast sensitivity prevents these patients from returning to driving.
Is optic neuropathy reversible? It depends on the type of optic neuropathy. Nonarteritic optic neuropathy cannot be cured, but around 40% restore some vision naturally. Arteric optic neuropathy also cannot be cured, but quick treatment can prevent the issue affecting the other eye.What age does ischemic optic neuropathy occur? ›
Arteritic Anterior Ischemic Optic Neuropathy (AAION) is an acute, often painful optic neuropathy that occurs predominantly in elderly patients over age 50 but with increasing incidence each decade thereafter and can cause permanent loss of vision.What is the difference between anterior and posterior ischemic optic neuropathy? ›
Pathogenetically AION and PION are very different diseases. AION represents an acute ischaemic disorder of the ONH supplied by the posterior ciliary artery (PCA), while PION has no specific location in the posterior part of the optic nerve and does not represent an ischaemic disorder of any definite artery.What is the end stage of the optic nerve disease? ›
Optic atrophy is the end stage of a disease process affecting the retinogeniculate portion of the visual pathway, characterized by a non-specific sign of optic disc pallor.What is the cause of PION? ›
PION is due to ischemia of the posterior optic nerve, which is supplied by only the pial capillary plexus. PION can lead to variable but sometimes profound vision loss due to a lack of perfusion to the posterior segment of the optic nerve.Can stress cause ischemic optic neuropathy? ›
Similarly, optic neuropathies can be with or without trauma, developmental anomalies, genetic mutations, etc. On the other hand, there are specific diseases, like normal-tension glaucoma and anterior ischemic optic neuropathy (AION), where stress can clearly be identified as a major cause.What diseases cause optic neuropathy? ›
- Autoimmune diseases, including lupus, sarcoidosis, and Behçet disease.
- Cryptococcosis, a fungal infection.
- Bacterial infections, including tuberculosis, syphilis, Lyme disease, and meningitis.