Bilateral Sequential Non-arteritic Anterior Ischemic Optic Neuropathy Induced by Methamphetamine Abuse

Non-arteritic anterior ischemic optic neuropathy (NAION) is a relatively common optic neuropathy in older aged adults above the age of 50. This disease can also present in patients of younger age, although much less common. The vast majority of these younger patients have associated risk factors for NAION, including hypertension and diabetes. Here, we present a case in which a previously healthy 41-year-old woman developed bilateral sequential NAION induced by methamphetamine abuse.

176 Bilateral Sequential Non-arteritic Anterior Ischemic Optic Neuropathy Induced by Methamphetamine Abuse Caroline Cotton 1, Nancy Vilar 1 1 University of Virginia Introduction: Non-arteritic anterior ischemic optic neuropathy (NAION) is a relatively common optic neuropathy in older aged adults above the age of 50. This disease can also present in patients of younger age, although much less common. The vast majority of these younger patients have associated risk factors for NAION, including hypertension and diabetes. Here, we present a case in which a previously healthy 41-year-old woman developed bilateral sequential NAION induced by methamphetamine abuse. Description of Cases: A 41-year-old woman without significant past medical history presented to neuro-ophthalmology clinic with acute vision loss in her left eye (OS) following a similar episode in her right eye (OD) two months prior. Vision was 20/40 OD and 20/15 OS. An afferent pupillary defect was present OS. Visual field testing showed incomplete altitudinal defect OD and inferior altitudinal defect with high reliability OS. Dilated fundus exam revealed cupless discs in both eyes, partial optic nerve atrophy superiorly OD, and Grade 2 optic nerve edema OS, with supporting results on optical coherence tomography. A full workup for potential etiologies of her presentation was performed. The only abnormality was substantial levels of methamphetamines and amphetamines in her urine drug screen. The patient was diagnosed with bilateral sequential NAION from methamphetamine abuse. She has not shown to her follow-up appointments. Conclusions, including unique features of the case: We report a case of bilateral sequential NAION in a patient younger than the typical age group for this disease, but with significant methamphetamine abuse precipitating each episode. Although methamphetamine abuse is not a known risk factor for NAION, this drug is known to cause vasoconstriction and vasospasms. Her small, crowded nerves are risk factors for ischemia in the setting of methamphetamine abuse, and with a negative medical history of other systemic diseases, this case presents compelling evidence that methamphetamine abuse may precipitate NAION. References: None provided. Keywords: Optic neuropathy, Visual fields Financial Disclosures: The authors had no disclosures. Grant Support: None. Contact Information: Caroline Cotton, [e-mail] 2024 Annual Meeting Syllabus | 231