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Non-Arteritic Anterior Ischaemic Optic Neuropathy — SCE Neurology MCQ

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ModerateNeuro-ophthalmologyNon-Arteritic Anterior Ischaemic Optic NeuropathySCE Neurology

A 65-year-old man with hypertension and diabetes presents with sudden painless loss of vision in the left eye. Visual acuity is counting fingers. Left RAPD is present. Fundoscopy shows pale, swollen optic disc with flame haemorrhages. The right eye is normal. What is the most likely diagnosis?

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Correct answer: A — Anterior ischaemic optic neuropathy – non-arteritic

Non-arteritic anterior ischaemic optic neuropathy (NAION) is the most common acute optic neuropathy in patients over 50. It presents with sudden painless visual loss, altitudinal visual field defect, pale swollen disc with haemorrhages, and RAPD. Risk factors include hypertension, diabetes, and small optic disc ("disc at risk"). C: GCA-associated AION would require ESR/CRP and temporal artery biopsy to exclude, but the presence of hypertension and diabetes suggests NAION. A: Optic neuritis is painful and occurs in younger patients. D: CRAO shows cherry-red spot without disc swelling. E: Papilloedema is bilateral.

Reference: ABN Neuro-ophthalmology Guidelines; EFNS AION Guidelines