Bilateral Posterior Ischemic Optic Neuropathy in a Patient with Atrial Fibrillation and Multifocal Embolic Stroke

Posterior ischemic optic neuropathy (PION) is a rare optic neuropathy of vascular origin involving the retrobulbar optic nerve and unaccompanied by optic disc edema, which iis usually a diagnosis of exclusion when other causes of retrobulbar optic neuropathy such as inflammation, toxicity, and compression are eliminated. PION can be classified into three main categories based on etiology. Typically, PION presents with monocular visual loss, especially the non-arteritic form. Simultaneous bilateral visual loss is usually encountered in the perioperative type of PION where perfusion abnormalities to the eyes occur, and the arteritic form may cause sequential progressive bilateral visual loss. Herein, we describe a patient who presented with sequential bilateral visual loss accompanied by multiple embolic cerebral infarcts and uncontrolled severe AF, diagnosed as non-arteritic PION, which has not been previously reported in the literature.