Arteritic Posterior Ischemic Optic Neuropathy: A Case Report

Purpose: To report a case of arteritic posterior ischemic optic neuropathy. Methods: A case report. Result: An 83-year-old gentleman with a past history of thalassemia minor complained of progressive decreased vision in his right eye as well as right side headache and jaw claudication. Initially, the best-corrected visual acuity (BCVA) was 6/100 in the right eye and 6/12 in the left eye. There was no relative afferent pupillary defect (RAPD). Fundus examination and fluorescein angiography were normal except some drusen in both eyes. BCVA in his right eye dropped to no light perception 2 weeks later, and RAPD developed in the same eye. Brain magnetic resonance imaging (MRI) was arranged but there was no unremarkable finding. His visual-evoked potential (VEP) study showed no pick-up response in the right eye. Laboratory evaluation uncovered mild anemia and increased erythrocyte sedimentation rate (ESR ＞ 120 mm/hour). As arteritic posterior ischemic optic neuropathy affecting his right eye was suspected, oral corticosteroid was prescribed. The visual acuity improved to light perception, and the pupillary light response returned. Symptoms relapsed 6 weeks after the cessation of oral medications and prolonged P100 response in the left eye was noted in VEP study follow-up. The vision in both his eyes remained stationary and the ESR and CRP returned back to normal limits with oral corticosteroid continuing. Conclusion: With the image of progressive decreased vision in elderly, we should not neglect the possibility of arteritic ischemic optic neuropathy even lack of a positive relative afferent pupillary defect sign or papilledema. The presence of signs and symptoms of temporal arteritis ought to be carefully sought, and high-resolution magnetic resonance imagings as well as color-coded duplex sonography are helpful in diagnosis making before the results of temporal artery biopsy are available. High-dose systemic steroids should be employed immediately for preserving vision of the fellow eye and in some instances may reverse vision loss in the affected eye.