Clinical manifestations and diagnosis of fundus ischemic optic neuropathy

Eye diseases are common among the elderly, especially those over 60 years old. One of the more common diseases is ischemic optic neuropathy. Ischemic optic neuropathy affects men and women at a very high rate, and there is a certain chance that it will occur in both eyes, causing visual impairment.

1. Causes of fundus ischemic optic neuropathy

1. Vasculitis: giant cell arteritis, polyarteritis nodosa, systemic lupus erythematosus, Buergers disease, allergic vasculitis, post-viral vasculitis, post-immunization, syphilis, and radiation necrosis.

2. Systemic vascular disease: hypertension, atherosclerosis, diabetes, migraine, large arteritis, carotid artery obstructive lesions

3. Hematological diseases: polycythemia vera, sickle cell disease, acute hypotension (shock), G-6-PD deficiency 4. After cataract surgery, hypotension, glaucoma

2. Clinical manifestations

Generally, the vision loss is not serious. However, if it is caused by temporal arteritis, it will be more serious and may even lead to loss of light perception. The onset is usually sudden. In the early stage, the optic disc is slightly swollen and appears light red, which is caused by the dilation of capillaries on the surface of the optic disc. More often, it is grayish white and limited to a certain quadrant of the optic disc, which is consistent with visual field loss. Bilateral rarely. There may be a small number of nerve fiber layer hemorrhages around the optic disc, which disappear on their own within 1 to 2 weeks. Flocculent exudate may also be seen. Optic atrophy occurs after 1 to 2 months and may be cup-shaped like optic atrophy in glaucomatous eyes. Secondary to giant cell arteritis or arteriosclerosis, the retinal blood vessels are generally normal. People with hypertension or arteriosclerosis may show corresponding changes in retinal arteriosclerosis.

III. Diagnosis and Differentiation of Fundus Ischemic Optic Neuropathy

For anyone over 40 years old who has a sudden decrease in vision and a non-tangent visual field loss, the possibility of ischemic optic neuropathy should be considered. However, compressive optic neuropathy, demyelinating diseases and hereditary diseases must be excluded.

1. Sudden decrease in vision, typical visual field loss;

2. Headaches and eye marks, especially due to arteritis;

3. The optic disc is grayish white and edematous;

4. Fundus fluorescein angiography shows low fluorescence or slow or no fluorescence filling of the optic disc;

5. Raynaud phenomenon in the hands and feet;

6. The intraocular pressure recovery rate of the eyeball compression test is significantly low.