Anterior ischemic optic neuropathy: sense and nonsense in diagnosis and treatment

In 15 consecutive patients with AION the cause was found to be giant-cell arteritis in 3 cases and was thought to be local arteriosclerosis of the posterior ciliary arteries in 12 cases, in spite of rheumatic factors which were found initially. In 87% of cases symptoms or factors indicating generalised arteriosclerosis were found. In one case before the AION cilioretinal emboli had been found. It is reported that the second eye is affected after a varying interval of time in +/- 50% of cases. In our material the arteriosclerotic form of AION occurred bilaterally in +/- 40% of cases with an interval varying from a few days to 5 years. The average interval for this form of AION is 3 years. Cerebral angiography was of no help in tracing the cause of the AION. A fluorescein angiogram is often made too late to show the characteristic circulatory disturbance in the peripapillary choroid and is usually not necessary. Therapy should be started immediately, with large doses of corticosteroids in all cases of AION, until biopsy of the temporal artery proves negative or the ESR is practically normal. Hypertension and diabetes should be treated adequately as protection for the other eye in the arteriosclerotic form of AION. In addition long-term anticoagulant therapy should be considered: a prospective study into this aspect has been started.