Nonarteritic Ischemic Optic Neuropathy

This 32 year old mentally retarded, deaf woman with hypertension and diabetes mellitus complained of sudden loss of vision of the right eye. The visual acuity could not be determined reliably, nor could visual field testing be performed. The right fundus showed a tilted optic nerve with a swollen optic nerve rim (yellow arrow). Splinter hemorrhages were present around the disc (green arrow). The left optic disc was tilted but not swollen. There was no headache or other symptoms to suggest temporal arteritis, which would be unusual in any case in a patient of this age. Nonarteritic ischemic optic neuropathy is thought to be caused by hypoperfusion of the optic nerve by the posterior ciliary arteries in patients with vascular risk factors. Nocturnal arterial hypotension may be the precipitating event. There is no effective treatment known.