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Anterior ischemic optic neuropathy precipitated by acute primary angle closure
Nikhil S Choudhari1, Ronnie George, Vardhman Kankaria
1Department of Glaucoma, Jadhavbhai Nathamal Singhvi, Medical Research Foundation, Sankara Nethralaya, Chennai-600 006, India.
Indian Journal of Ophthalmology
|August 7, 2010
Summary
A rare case of non-arteritic anterior ischemic optic neuropathy (NAION) occurred after acute primary angle closure in a hypotensive patient. Optical coherence tomography detected axonal swelling, unlike scanning laser polarimetry.
Area of Science:
- Ophthalmology
- Neuro-ophthalmology
- Optic Neuropathy
Background:
- Systemic hypotension can predispose individuals to optic neuropathies.
- Acute primary angle closure is a known cause of secondary optic nerve damage.
- Non-arteritic anterior ischemic optic neuropathy (NAION) is typically associated with normal or low intraocular pressure.
Observation:
- A 59-year-old male with chronic hypotension presented with sequential acute primary angle closure in both eyes.
- The patient subsequently developed asymmetric non-arteritic anterior ischemic optic neuropathy (NAION).
- Intraocular pressure was elevated during the angle closure episodes.
Findings:
- NAION is exceptionally uncommon in the context of elevated intraocular pressure.
- Optical coherence tomography (OCT) successfully identified axonal swelling.
- Scanning laser polarimetry (SLP) failed to detect the axonal swelling, contrasting with OCT findings.
Implications:
- This case highlights a rare association between NAION and acute primary angle closure in a hypotensive patient.
- The differential diagnostic capabilities of OCT and SLP in optic nerve pathologies warrant further investigation.
- Understanding the pathophysiology of NAION in unusual circumstances may refine diagnostic and treatment strategies.
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