Título

NON-ARTERITIC ANTERIOR ISCHAEMIC OPTIC NEUROPATHY AS A DIFFERENTIAL DIAGNOSIS OF ATYPICAL OPTIC NEURITIS: A CASE REPORT

Introdução

Non-arteritic anterior ischemic optic neuropathy (NA-AION) is an important cause of acute visual loss in middle-aged and elderly populations. It is a well-established clinical entity, characterized by sudden and painless loss of vision and optic disc edema. The etiology is believed to be multifactorial. Our goal is to report an atypical case of a pacient with non-arteritic anterior inchaemic optic neuropathy whose similar evolution was rarely found in the literature.

Métodos

The information was obtained from the medical records and through interviews with the patient and photographic record of the diagnostic methods were associated to the literature review.

Resultados

AMF, male, 78 years old, type 2 diabetic, hypertensive for 5 years and dyslipidemic, with a complaint of progressive bilateral visual loss acuity for 1 year. He presented for evaluation in November 2018 with nuclear cataract of 3+ and anterior subcapsular cataract of 1+ in both eyes. Although the central visual acuity was equivalent between the eyes (20/80), the patient reported greater blurring and loss of field in the left eye (LE) for about 20 days. Fundoscopy showed signs of grade 2 hypertensive retinopathy in both eyes and diffuse papillary edema with mild peripapillary hemorrhage in the LE. Patient underwent cranial and orbit tomography which was normal. Due to the condition of disc edema associated with “candle flame” hemorrhage, in a papilla with small excavation, the main diagnostic hypothesis of NA-AION was raised. The patient was reexamined in January 2019 with residual optic edema in the LE, but with papilla edema and recente inferior peridiscal hemorrhage on the right eye (RE). The visual acuity at this time had dropped to 20/200 in the RE and improved to 20/60 in the LE. Due to the painless presentation, with similar characteristics to the LE, the clinical diagnosis of bilateral NA-AION was confirmed.

Conclusões

In this case, we highlight the complaints of acute painless visual loss and fundoscopic changes of the disease bilaterally: small, edematous optic disc with peripapillary hemorrhage and normal neuroimaging. For these reasons, we arrived at the diagnosis of sequential bilateral NA-IAON, first affecting LE, and after RE, with partial recovery of visual acuity and spontaneous improvement of the edema in 4 to 6 weeks, with visual field sequel. Old age and clinical edema rule out Leber. And bilateral visual impairment with spontaneous self-resolving edema within 6 weeks excludes optic neuritis.

Palavras Chave

Non-arteritic anterior ischemic optic neuropathy, optic nerve edema, visual acuity loss

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