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Ischemic optic neuropathy is an eye disease that causes vision loss, often worse in one eye than the other, due to inflammation or damage in nearby blood vessels. It may be a sign of a serious underlying health problem, and treatment includes prescription medications and addressing underlying conditions. Diagnosis is made by an ophthalmologist, and treatment decisions are based on the underlying causes.
Ischemic optic neuropathy is an eye disease most commonly seen in people over the age of 50. It is characterized by mild to severe vision loss that is usually painless and worse in one eye than the other. Vision problems occur when the optic nerve doesn’t get a constant supply of new oxygen-rich blood due to inflammation or damage in nearby blood vessels. Ischemic optic neuropathy may or may not be a sign of a very serious underlying health problem called giant cell arteritis, so it’s important to visit a doctor at the first signs of worsening vision problems in order to receive an accurate diagnosis. Most patients are able to recover at least some vision with prescription medications.
Most cases of ischemic optic neuropathy are related to problems with the anterior section of the optic nerve, the part closest to the eye which is also called the optic disc. The disc collects information from millions of tiny nerve endings in the eye and transmits signals to the brain. To function properly, it needs a constant supply of oxygenated blood. If the blood vessels leading to the disc are weak or damaged, the nerve becomes less effective at transmitting signals. As a result, visual acuity and light perception decreased.
The cause of ischemic optic neuropathy isn’t always clear. Many patients have underlying conditions that increase the risk of blood vessel problems and damage to the optic disc, such as diabetes, arthritis, high cholesterol, high blood pressure and heart disease. Problems occur when blood circulation in the eye is poor, leading to a sudden, sharp drop in eye blood pressure and swelling of the optic disc. Giant cell arteritis is a rare but serious potential cause that induces inflammation of blood vessels throughout the head and neck, including the delicate vessels in the eyes.
Most cases that don’t involve arteritis are painless. Visual impairment tends to progress rapidly, sometimes within days or even hours. Some people wake up from a night’s sleep to find that they can’t see well or can’t see at all in one eye. It is also common for a person to lose the ability to detect subtle nuances of color, depth and brightness. Vision can also become very blurry or blurry. If arteritis is present, a person may have additional symptoms such as fever, head and neck pain, and fatigue.
An ophthalmologist can diagnose ischemic optic neuropathy with a clinical exam. A specialized microscope is used to view the optic disc and surrounding blood vessels to look for signs of inflammation. If a problem is discovered, blood tests are needed to confirm or rule out arteritis. Treatment decisions are made based on the underlying causes, when they can be discovered.
Ischemic optic neuropathy is usually treated with oral or injected steroids to relieve acute inflammation. Underlying factors such as diabetes or high cholesterol are treated accordingly with medication or surgery. Arteritis can require a very long course of anti-inflammatory drugs and drugs that suppress the immune system. Outlook may vary, but most people who get prompt treatment start seeing better within a few days.
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