Complaints & connections · borters.ch
Neuropathia optica ischaemica anterior
Two forms, and the rare one is an emergency: over fifty, with headache and pain on chewing, treatment starts before the sample is in — it is about the second eye.
Also known as: anterior ischemic optic neuropathy · AION · optic nerve blood flow disorder
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
In an optic nerve infarct the front section of the nerve no longer receives enough blood. The loss of sight comes suddenly, is painless and typically affects the upper or lower half of the field of vision — as if a curtain had been drawn from one side. Everything else hangs on a single distinction, and it is urgent. In the far commoner form the blood supply is tight for mechanical reasons: a narrow, tightly packed optic nerve head, together with night-time drops in blood pressure, sleep apnoea, diabetes, smoking. In the rarer form an inflammation of the temple arteries lies behind it, giant cell arteritis — and that is an emergency, because without immediate treatment it can take the second eye within days. Pointing to it are an age over fifty, new headaches, a tender temple, pain on chewing that forces a pause, stiffness in shoulders and hips, fever and weight loss. In that situation treatment is begun before the tissue sample is available. In the first eye little can usually be brought back; the whole effort is for the second. Two figures about the same inflammation, because they explain why nothing here is put off until tomorrow: **without treatment the second eye is affected in about 60 in 100 cases, with treatment in about 15.** And a caveat that goes with it: inflammatory blood values are measured the same day, but **in about 4 in 100 of those affected they are normal** while the inflammation is running. A normal result does not rule it out — with a pressing suspicion treatment starts regardless.
Over fifty, with a new headache, a tender temple or pain on chewing: then the arteritis is in the room, and treatment begins before confirmation — it is about the second eye.
Two values available the same day that decide on immediate treatment. Waiting here costs the second eye.
The tissue sample from the temple artery stays informative for days after treatment has begun. So it is not waited for — the order is deliberate.
Hardly anyone volunteers that they have to pause while eating. Yet it is the most telling sign — so the question belongs asked.
In the common form it is one of the few genuinely modifiable factors. Treating it is prevention for the second eye.
A night-time blood pressure that is too low is regarded as a contributing cause. Whether evening doses are moved belongs discussed — and not decided alone.
In the affected eye little can usually be brought back. Blood pressure, sugar, stopping smoking and treating the sleep apnoea therefore count for the side that still sees.
In the common form of optic nerve infarct there is no treatment that brings sight back — neither cortisone nor blood thinners managed it in studies. What counts is the second eye: blood pressure, sugar, fats, sleep apnoea. Blood pressure drugs are not taken in the evening, because the night-time low is regarded as a trigger. In the inflammatory form from giant cell arteritis it is the opposite — there, immediate cortisone saves the second eye.
The loss of vision is usually noticed on waking and typically affects the lower half of the field. About two to ten per hundred thousand people over fifty are affected each year. In the non-inflammatory form the other eye is affected in about fifteen in a hundred cases over five years. In the inflammatory form from giant cell arteritis it is up to fifty within days without immediate treatment — which is why the sedimentation rate is measured at once.
The loss typically affects a horizontal half of the field of vision. This shape of loss is characteristic and helps to tell it from other causes.
Onset on waking is typical, because blood pressure is lowest at night. So night-time blood pressure and sleep apnoea belong to the workup.
This is the most telling single sign of the inflammatory form. Anyone who has to stop while eating an apple or a piece of meat belongs assessed at once.
A scalp tender over the temple, sometimes with a thickened, pulseless cord. Together with new headaches over fifty this is the classic combination.
Giant cell arteritis often occurs together with muscle stiffness in the shoulder and pelvic girdle. This detail is rarely volunteered — asking for it is worthwhile.
The first value in anyone over fifty with sudden loss of sight. Clearly raised together with the matching complaints is enough to begin treatment at once.
Always belongs measured together with the ESR, because the two complement each other. If both are normal the inflammatory form is very unlikely — but not impossible.
In giant cell arteritis the platelets are often raised and the haemoglobin slightly low. Two quiet additional hints that round out the picture.
In the common, non-inflammatory form the sugar is among the factors that can be influenced for the sake of the second eye.
These two pigments gather exactly at the place of sharpest vision and filter short-wave light there. Kale, spinach, chard, broccoli and egg yolk are the sources.
The retina holds particularly much zinc; it is needed to turn light into a signal. High doses over months lower copper, though — so the two are considered together.
The outer segments of the seeing cells consist largely of a long-chain omega-3 fatty acid, and the tear film needs it too.
The seeing pigment is built from vitamin A. A lack shows first as poor vision at dusk and as a dry surface of the eye.
The optic nerve has suffered an infarct — that is a vascular event, and it is over before anything can be taken. What counts is aimed at the other eye: blood pressure, blood sugar, blood fats, and the question of a nocturnal fall in blood pressure and of sleep apnoea.
Well studied for the vessels overall, not for this one vessel. Two to four portions of oily fish a week is the frame in which the benefit was found — high-dose capsules did not repeat it in the large trials.
The decisive point: if giant cell arteritis is behind it, cortisone is started at once — before the biopsy. Otherwise the second eye is at risk within days. Headache, jaw pain on chewing and a high inflammation value are the signs.
In the more common form without arteritis, diabetes, high blood pressure and sleep apnoea are the companions. The night-time fall in blood pressure is a point of its own — blood pressure medicines in the evening are questioned here.
After an optic nerve infarct it is about the vessels as a whole — blood pressure, sugar, blood fats. Blood pressure medicines are usually not taken in the evening, because the night-time low is a risk factor.
AWMF 045-013 · S2e · 2022-10 — in force
Retinale arterielle Verschlüsse (RAV)
checked 2026-09