Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) With Segmental Optic Disc Edema

A 75-year old white woman with hypertension and diabetes presented with a 1 week history of vision loss in the right eye. Dilated fundus examination revealed superior segmental optic disc edema in the right eye and a small, crowded optic disc in the left eye known as a "disc-at-risk" (Figure 1). Intravenous fluorescein angiogram showed leakage from the superior part of the optic disc (Figure 2). Humphrey 24-2 SITA-Fast visual fields showed a right inferior arcuate defect (Figure 3). She had normal laboratory investigations including complete blood count (CBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and was diagnosed with right NAION. She was seen in follow-up 6 weeks later and there was resolution of the right optic disc edema (Figure 4) and her right inferior arcuate defect was stable (Figure 5). Optic coherence tomography of the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC), which includes the ganglion cell layer and inner plexiform layer, showed mild right superior RNFL loss and macular GCC loss corresponding to the right inferior visual field defect (Figures 6 and 7). [[Number of Figures and legend for each: 7 figures included. Figure 1. Optic disc photos of both eyes demonstrating right superior segmental optic disc edema and a left small, crowded optic nerve ("disc-at-risk"). Figure 2. Intravenous fluorescein angiography showed leakage from the superior part of the optic disc. Figure 3. Humphrey 24-2 SITA-Fast visual fields show a right inferior arcuate defect. Figure 4. Optic disc photos show resolution of the right optic disc edema. Figure 5. Humphrey 24-2 SITA-Fast visual fields show a stable right inferior arcuate defect. Figure 6. Optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) shows mild thinning superiorly in the right eye and OCT macular ganglion cell analysis shows superior GCC loss. Figure 7. Deviation maps of the optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) shows mild thinning superiorly in the right eye and OCT macular ganglion cell analysis shows superior GCC loss corresponding to the inferior visual field defect.]]