Optic Neuropathy

Anterior ischemic optic neuropathy is the most common cause of acute optic neuropathy in older age groups. It can be nonarteritic, which is usually associated with conditions such as hypertension, diabetes mellitus, hyperlipidemia, and obstructive sleep apnea; or arteritic, which is associated with an inflammatory condition called giant cell arteritis.  Visual loss is painless in at least 90% of patients with nonarteritic ischemic optic neuorpathy and the vision loss is usually noticed upon awakening.  Patients with arteritic anterior ischemic optic neuropathy associated with giant cell arteritis often have symptoms other than visual loss, such as malaise, headache, scalp tenderness and tender temporal arteries, jaw pain on chewing, fevers, weight loss and generalized muscle aches.  Both causes of optic neuropathy can be permanently debilitating and must be treated immediately.  Other causes of optic neuropathy must also be considered as tumors, thyroid eye disease, inflammatory and infectious etiologies can all compress or infiltrate the optic nerve.