Acute ischemic optic nerve disease: Pathophysiology, clinical features and management.

Area of Science:

• Ophthalmology
• Neurology
• Vascular Medicine

Background:

• Ischemic optic neuropathies (IONs) are a primary cause of severe vision loss in individuals over 50.
• IONs encompass diverse clinical, etiological, and therapeutic entities, necessitating precise differentiation.
• Anatomical classification includes anterior and posterior forms of ION.

Purpose of the Study:

• To synthesize current knowledge on ischemic optic neuropathies.
• To discuss pathophysiological and therapeutic controversies surrounding IONs.
• To guide clinicians in identifying risk factors and preventing contralateral recurrence.

Main Methods:

• Literature review and synthesis of validated data.
• Discussion of etiological factors, including giant cell arteritis and non-arteritic ION.
• Analysis of predisposing and precipitating factors in non-arteritic ION.

Main Results:

• Arteritic ION due to giant cell arteritis requires immediate corticosteroid treatment to prevent blindness and mortality.
• Non-arteritic ION often involves local factors (e.g., small optic nerves) combined with precipitating events (e.g., hypotension) and vascular risk factors.
• No specific treatment exists for non-arteritic ION; risk factor management is key to preventing recurrence.

Conclusions:

• Accurate diagnosis and timely intervention are critical for arteritic ION.
• Identifying and mitigating risk factors is essential for managing non-arteritic ION and reducing recurrence risk.
• Further research is needed to address ongoing debates regarding ION pathophysiology and treatment.