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Non-arteritic ischaemic optic neuropathy (NAION)

Disease
Anterior ischaemic optic neuropathy entails swelling of the anterior portion of the optic nerve in association with visual disturbance, and may relate to occlusion of the short posterior ciliary arteries.

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When associated with giant cell arteritis (GCA, temporal arteritis), the condition is referred to as arteritic ischaemic optic neuropathy (AION). NAION (that is without evidence of arteritis) occurs mostly in patients aged over 45 years. Patients are usually otherwise well, although many have associated cardiovascular risk factors including hypertension, diabetes, hyperlipidaemia and smoking. Since over half of patients first notice the visual deficit upon awakening, it has been suggested that nocturnal hypotension may contribute to its onset.

Symptoms

The usual presentation is sudden, painless, unilateral loss of vision with no preceding visual symptoms. The clinician should enquire specifically regarding symptoms consistent with giant cell arteritis (GCA) such as, fever, myalgias, temporal headache and scalp tenderness.

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