Delhi Journal of Ophthalmology

Bilateral Non-Arteritic Anterior Ischemic Optic Neuropathy in a Young Male

Minal Kanhere, Reshma Ramakrishnan, Ayushi Choudhary
MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India

Editor-in-Chief, Delhi Journal of Ophthalmology, Dr R.P.Centre, AIIMS.


Corresponding Author:

Minal Kanhere MBBS, MS (3rd Year)
C-2, RH_2, Gadge Maharaj Marg,
Near HP Gas Godown, Sector-6, Vashi,
Navi Mumbai - 400703, Maharashtra, India
Email id: mdkanhere90@gmail.com


Received: 30-DEC-2018 Accepted: 06-FEB-2019 Published Online: 05-MAY-2019
DOI: https://dx.doi.org/10.7869/djo.463

Abstract
A 43 year old diabetic male presented with complaints of blurring of peripheral vision, in the left more than right eye, since a couple of months. Best corrected visual acuity was 6/9 in the right eye and 6/24 in the left eye. Dilated fundus examination showed a slightly edematous disc superiorly with a cup:disc ratio of 0.1:1 in the right eye and nasal disc pallor with a cup:disc ratio of 0.1:1 in the left eye. Visual fields examination was suggestive of a partial inferior altitudinal defect in the left eye. OCT showed nerve fibre layer thinning and cup:disc ratio of 0.14:1 in the left eye. A diagnosis of bilateral NAION was made. Serum cholesterol levels were raised. VEP was advised which was suggestive of bilateral axonopathic optic neuropathy. The patient was started on a combination of Syndopa-Carbidopa, Aspirin and Atorvastatin. On follow-up, visual acuity improved to 6/12 in the left eye. Field defect was reduced slightly compared to the previous examination. The pathogenesis of NAION remains unclear but may involve ischemia to the optic nerve head from insufficient perfusion of the short posterior ciliary arteries. The most important structural risk factor is a small and crowded disc. The presentation in young patients is similar to elderly patients having classical AION. Prompt diagnosis and management gives a better chance of visual improvement in younger patients.

Keywords :Nonarteritic ischaemic optic neuropathy, Crowded disc, Diabetes