Abstract
Anterior ischaemic optic neuropathy (AION), a common, visually crippling disorder, is discussed, with particular emphasis on differentiating AION due to giant cell arteritis (arteritic AION) from that not due to it (non-arteritic AION). Giant cell arteritis is an ophthalmic emergency because of imminent danger of bilateral total blindness, which is almost always preventable if the disease is quickly identified and treated urgently and aggressively. My studies have revealed that the best means of differentiating arteritic from non-arteritic AION is a combination of information from the following: systemic and visual symptoms of giant cell arteritis, high erythrocyte sedimentation rate and C-reactive protein, early massive visual loss, chalkywhite optic disc swelling, associated cilio-retinal artery occlusion, massive non-filling of the choroid on fluorescein fundus angiography and temporal artery biopsy. Management of giant cell arteritis and of arteritic AION is discussed. Current misconceptions about AION are pointed out.
Similar content being viewed by others
Article PDF
References
Hayreh SS and Baines JAB : Occlusion of the posterior ciliary artery III. Effects on the optic nerve head. Br J Ophthalmol 1972, 56: 754–64.
Hayreh SS : Anterior ischaemic optic neuropathy I. Terminology and pathogenesis. Br J Ophthalmol 1974, 58: 955–63.
Hayreh SS : Anterior ischemic optic neuropathy. New York. Springer-Verlag, 1975.
Hayreh SS : Pathogenesis of visual field defects—Role of the ciliary circulation. Br J Ophthalmol 1970, 54:289–311.
Hayreh SS : Structure and blood supply of the optic nerve. In Heilmann K, Richardson KT eds. Glaucoma: Conceptions of a disease. Pathogenesis, diagnosis, therapy, Stuttgart: Thieme 1978: 78–96.
Hayreh SS : Inter-individual variation in blood supply of the optic nerve head. Its importance in various ischemic disorders of the optic nerve head, and glaucoma, low-tension glaucoma and allied disorders. Doc Ophthalmol 1985, 59: 217–46.
Hayreh SS : Blood supply of the anterior optic nerve. In Ritch R, Shields MB, Krupin T eds. The Glaucomas, Vol. I. St Louis: CV Mosby 1989: 133–61.
Hayreh SS : Blood supply of the optic nerve head in health and disease. In Lambrou GN, Greve EL eds. Ocular blood flow in glaucoma. Amsterdam: Kugler & Ghedini 1989: 3–48.
Hayreh SS : The ophthalmic artery III. Branches. Br J Ophthalmol 1962, 46: 212–47.
Hayreh SS : Physiological anatomy of the choroidal vascular bed. Int Ophthalmol 1983, 6: 85–93.
Hayreh SS and Baines JAB : Occlusion of the posterior ciliary artery I. Effects on choroidal circulation. Br J Ophthalmol 1972, 56: 719–35.
Hayreh SS and Zahoruk RM : Anterior ischemic optic neuropathy VI. In juvenile diabetics. Ophthalmologica 1981, 182: 13–28.
Hayreh SS, Servais GE, Virdi PS : Fundus lesions in malignant hypertension V. Hypertensive optic neuropathy. Ophthalmology 1986, 93: 74–87.
Hayreh SS : Anterior ischemic optic neuropathy VIII. Clinical features and pathogenesis of posthemorrhagic amaurosis. Ophthalmology 1987, 94, 1488–502.
Hayreh SS : Optic disc edema in raised intracranial pressure VI. Associated visual disturbances and their pathogenesis. Arch Ophthalmol 1911, 95: 1566–79.
Hayreh SS : Anterior ischémie optic neuropathy IV. Occurrence after cataract extraction. Arch Ophthalmol 1980, 98: 1410–16.
Hayreh SS : Anterior ischemic optic neuropathy. Arch Neurol 1981, 38: 675–8.
Hayreh SS : Anterior ischemic optic neuropathy V. Optic disc edema an early sign. Arch Ophthalmol 1981, 99: 1030–40.
Beri M, Klugman MR, Kohler JA, Hayreh SS : Anterior ischemic optic neuropathy VII. Incidence of bilaterality and various influencing factors. Ophthalmology 1987, 94: 1020–8.
Beck RW, Servais GE, Hayreh SS : Anterior ischemic optic neuropathy IX. Cup-to-disc ratio and its role in pathogenesis. Ophthalmology 1987, 94: 1503–8.
Hayreh SS : Ischemic optic neuropathy. Int Ophthalmol 1978, 1: 9–18.
Hayreh SS and Podhajsky P : Visual field defects in anterior ischemic optic neuropathy. Doc Ophthalmol Proc Ser 1979, 19: 53–71.
Hayreh SS : Anterior ischaemic optic neuropathy II. Fundus on ophthalmoscopy and fluorescein angiography. Br J Ophthalmol 1974, 58: 964–80.
Jennings GH : Arteritis of the temporal vessels. Lancet 1938, 1: 424–8.
Paulley JW and Hughes JP : Giant-cell arteritis, or arteritis of the aged. Br Med J 1960, 2: 1562–7.
Hedlund P : Clinical and experimental studies on C-reactive protein (Acute phase protein). Acta Med Scand Suppl 1961, 361: 1–71.
Lawlor GJ and Fischer TJ : Manual of allergy and immunology—diagnosis and therapy. Boston. Little Brown & Co, 1984: 277.
Eshagian J and Goeken JA : C-reactive protein in giant cell (cranial, temporal) arteritis. Ophthalmology 1980, 87: 1160–6.
Bosley TM, Savino PJ, Sergott RC, Eagle RC, Sandy R, Gee W : Ocular pneumoplethysmography can help in the diagnosis of giant-cell arteritis. Arch Ophthalmol 1989, 107: 379–81.
Singh S and Dass R : The central artery of the retina I. Origin and course. Br J Ophthalmol 1960, 44: 193–212.
Birkhead NC, Wagener HP, Shick RM : Treatment of temporal arteritis with adrenal corticosteroids: results in fifty-five cases in which lesion was proved at biopsy. J Am Med Assoc 1957, 163: 821–7.
Cohen DN and Smith TR : Skip areas in temporal arteritis: myth versus fact. Trans Am Acad Ophthalmol Otolaryngol 1974, 78: OP772–83.
Albert DM, Ruchman MC, Keltner JL : Skip areas in temporal arteritis. Arch Ophthalmol 1976, 94: 2072–7.
Klein RG, Campbell RJ, Hunder GG, Carney JA : Skip lesions in temporal arteritis. Mayo Clin Proc 1976, 51: 504–10.
Wells KK, Folberg R, Goeken JA, Kemp JD : Temporal artery biopsies correlation of light microscopy and immunofluorescence microscopy. Ophthalmology 1989, 96: 1058–64.
Blodi FC : The temporal artery biopsy as a diagnostic procedure in ophthalmology. Trans Aust Coll Ophthalmol 1969, 1: 26–33.
Hedges TR III, Gieger GL, Albert DM : The clinical value of negative temporal artery biopsy specimens. Arch Ophthalmol 1983, 101: 1251–4.
Hall S, Lie JT, Kurland LT, Persellin S, O'Brien PC, Hunder GG : The therapeutic impact of temporal artery biopsy. Lancet 1983, 2: 1217–20.
Fauci AS : Alternate-day corticosteroid therapy. Am J Med 1978, 64: 729–31.
Ellenberger C : Ischemic optic neuropathy as a possible early complication of vascular hypertension. Am J Ophthalmol 1979, 88: 1045–51.
Guyer DR, Miller NR, Auer CL, Fine SL : The risk of cerebrovascular and cardiovascular disease in patients with anterior ischemic optic neuropathy. Arch Ophthalmol 1985, 103: 1136–42.
Author information
Authors and Affiliations
Additional information
These studies have been supported by a research grant from the National Institutes of Health (Grant No. EY-1151), and unrestricted grants from Research to Prevent Blindness, Inc, New York, and from the Alcon Research Institute
Rights and permissions
About this article
Cite this article
Hayreh, S. Anterior ischaemic optic neuropathy Differentiation of arteritic from non-arteritic type and its management. Eye 4, 25–41 (1990). https://doi.org/10.1038/eye.1990.4
Issue Date:
DOI: https://doi.org/10.1038/eye.1990.4
This article is cited by
-
Clinical, biological, and ophthalmological characteristics differentiating arteritic from non-arteritic anterior ischaemic optic neuropathy
Eye (2023)
-
Retrobulbar and intraocular blood flow in anterior ischaemic optic neuropathy are linked to the functional impairment
International Ophthalmology (2019)