Ischaemic optic neuropathy may be due

• to giant cell arteritis,
  • NIH.
  • here
• may be 'none-arteritic', that is not due to giant cell arteritis
  • links
  • professionals
  • experimental  Eye 2011

This is a condition of the elderly. It is explained in detail NIH.  The arteries to the eye become inflamed and block. Other arteries can be affected. Without its blood supply, the optic nerve 'infarcts'. It becomes swollen, and later pale.

The sight is damaged. Often half or nearly all the sight is greatly reduced in that eye.

The condition can affect the other eye.

The disease is an 'inflammatory' disease, and will be stopped with steroid treatment (in most cases). The steroid dose has to be very high.

Because the steroids have such serious side effects, it is very important to make the correct diagnosis

• in 90% of patients the ESR and CRP are very high
• in nearly all patients a temporal artery biopsy will show the condition (if enough artery is biopsied, at least 2 cm.
• most patients have other GCA symptoms, loss of weight, headache, feeling unwell, anaemia, for the last 3 moths
• 50% will have had polymyalgia...that is shoulder stiffness and muscle aches, jaw aches when eating (claudication) etc

Normally in Birmingham treatment is started and the biopsy carried out at Birmingham and Midland Eye Centre. Patients are then transferred to the neuro-ophthalmology team at the QE. The treatment

• high dose intravenous methyl-prednisolone for 3 days
• ESR  CRP, temporal artery biopsy, full examination and other tests are carried out
• steroid tablets are started at a high dose
• typically after a month the dose of prednisolone will have been reduced to 20 mg; after that by the second month 10mg ugh t be achieved, and then the dose reduced by 1mg a month for the next 10 months
• the steroid dose have to be increased if the ESR rises significantly
• we need to find alternative treatment to steroids so we can reduce side effects
• Walvick 2011 " The odds of a positive biopsy were 1.5 times greater with an erythrocyte sedimentation rate of 47 to 107 mm/hr, 5.3 times greater with a CRP >2.45 mg/dL, and 4.2 times greater with platelets >400,000/μL."

This is described here.

In this condition the arteries to the otic nerve block and the artery infarcts.

• there is no inflammation as there is in  GCA ION
• patients are younger
• some are arteriopaths..that is they smoke
• it is sometimes associated with a drop in blood pressure

The optic nerve of such patients tend to be smaller than normal, and the optic canal, the bony canal through which the optic nerve passes, narrower than normal. Such an optic nerve is said to be 'nerve at risk'.

So a typical patient,

• probably with a small optic nerve 'at risk',
• may be an ex-smoker,
• may have some hip surgery.
• After the surgery that may develop haematemesis (vomiting blood) and
• the blood pressure may drop, and then
• the vision goes (as the optic nerve infarcts due to lack of blood supply).

There is no treatment.

• Aspirin is prescribed.
• Smoking needs to stop

In such a patient when the condition is brought on by a drop in blood pressure, there should be no further episodes. But if there are no 'precipitating' factors the condition may recur later in the other eye.

Apologies to visitors for all the site moves. It is now here www.goodhopeeyeclinic.org.uk/  and hopefully will not move again.