Posterior Ischemic Optic Neuropathy

    • Core features
      • Painless acute monocular (less commonly binocular) loss of vision
      • Visual acuity is normal or depressed
      • Nerve fiber bundle visual field defects
      • Afferent pupil defect unless vision loss is equal in both eyes
      • Ophthalmoscopically normal-appearing optic disc
      • Predisposing condition should be evident, most commonly systemic hypotension
    • Possible accompanying features
      • MRI retrobulbar optic nerve enhancement, high T2/FLAIR and thickening, or restricted diffusion
    • Radiation-induced optic neuropathy
    • Hypotensive optic neuropathy
    • Optic neuritis
    • Arteritic ischemic optic neuropathy
    • Compressive optic neuropathy
    • Infiltrative optic neuropathy
    • Paraneoplastic optic neuropathy
    • Leber hereditary optic neuropathy
    • Chiasmal and retrogeniculate visual loss (but should show hemianopic rather than nerve fiber bundle visual field defects)
    • Exclude arteritic ischemic optic neuropathy in all elderly patients
    • Look for provocative settings
    • Trap: do not make this diagnosis unless a provocative setting is evident
    • Perform orbit/brain MRI primarily to exclude a non-ischemic cause
    • Provide treatment based on the cause
    • Visual prognosis depends on the cause and on how much damage has occurred

    Optic Nerve And Chiasm Disorders

    Drusen Optic Neuropathy Colobomatous Optic Neuropathy Optic Pit Neuropathy Morning Glory Optic Neuropathy Hypoplastic Optic Neuropathy Typical Optic Neuritis Atypical Optic Neuritis Papillitis (Neuroretinitis) Non-arteritic Ischemic Optic Neuropathy Arteritic Ischemic Optic Neuropathy Posterior Ischemic Optic Neuropathy Hypotensive Ischemic Optic Neuropathy Radiation-induced Optic Neuropathy Diabetic Papillopathy Hypertensive Optic Disc Edema Papilledema Idiopathic Intracranial Hypertension (Pseudotumor Cerebri) Compressive Optic Neuropathy: Overview Optic Neuropathy of Graves Disease Optic Nerve Sheath Meningioma Sphenoid Meningioma Craniopharyngioma Pituitary Adenoma Pilocytic Astrocytoma (Optic Glioma) Carotid Aneurysm Suprasellar Germinoma Infiltrative (Neoplastic) Optic Neuropathy Paraneoplastic Optic Neuropathy Traumatic Optic Neuropathy Toxic Optic Neuropathy Nutritional Deficiency Optic Neuropathy Dominantly-Inherited Optic Neuropathy Leber Hereditary Optic Neuropathy Primary Open Angle Glaucoma