A 46-year-old man was referred to our department complaining of a bilateral progressive decrease in his visual acuity. Fundus examination revealed bilateral optic disc oedema, indicative of anterior ischaemic neuropathy (AION), and a macular star in the right eye. Laboratory analysis showed low haematocrit and haemoglobin, elevated creatinine, and increased erythrocyte segmentation rate and C-reactive protein level. Physical examination revealed the presence of purpuric rash on the trunk and the extremities. During the investigation we performed a complete laboratory and imaging examination for autoimmune collagen diseases, vasculitides and infectious diseases, which were all negative. Histologic findings of renal biopsy were compatible with IgA glomerulonephritis and thus Henoch-Schönlein purpura (HSP) diagnosis was established. The patient was treated with methylprednisolone and cyclophosphamide. Six months later, his renal function and his visual acuity had improved, and the rash had subsided. This is a rare case of AION in a patient with HSP.

Non-arteritic anterior ischemic optic neuropathy (NAION) is a rare complication following acute bleeding. Patients present with varying vision loss and visual field defects. NAION is more commonly developed in patients with systemic disorders that may affect normal blood flow such as hypertension and diabetes. In this case, we report a 54-year-old man who complained of vision blurring following an episode of acute gastric bleeding. This report aims to review the pathology of this condition and present the findings of newer non-invasive imaging modalities of the vascular layers of the posterior pole of the eye like optical coherence tomography angiography (OCTA), which facilitates the proper diagnosis and prognosis of such cases. Finally, we present the management options for this patient with antiplatelet treatment.

Purpose To present a case of non‐arteritic anterior ischemic optic neuropathy due to hypovolemia. Methods A 54 year‐old male was referred to the ophthalmology department with a history of blurred vision in his right eye following acute bleeding due to duodenal ulcer 5 days ago. Complete ophthalmological examination was performed, including best corrected visual acuity (BCVA), visual field, optical coherence tomography (OCT) and OCT‐angiography (OCT‐A). Results His BCVA was 3/10 in his right and 2/10 in his left eye (history of amblyopia since childhood). Fundus examination of his right eye revealed optic disc edema and peripapillary flame‐shaped hemorrhages with cotton wool spots nasally to the fovea. There were only a few flame‐shaped hemorrhages at the peripapillary area in his left eye. OCT imaging of his right eye revealed an area of increased reflectivity mainly at the inner retinal layers associated with small increase in retinal thickness nasally to the fovea. A month later OCT documented reduced retinal thickness at the aforementioned area, where in OCT‐A there was capillary drop out, mainly at the deep capillary plexus, with decreased vascular density. Visual fields revealed generalized depression in OD with minimal findings in OS. Based on the above, the diagnosis of non‐arteritic anterior ischemic optic neuropathy following acute blood loss was set. The patient received blood transfusion immediately after his hospital admission. Although his general symptoms improved shortly after treatment there was only a partial visual recovery as decreased vascular perfusion was persisting four months later. Long‐term anticoagulation therapy was also given to the patient. Conclusions Patients reporting blurred vision after acute massive bleeding that could lead to hypovolemia should be investigated for ischemic optic neuropathy. OCT‐A helps monitoring vessel abnormalities in areas of compromised blood perfusion and may explain poor visual outcomes in such cases.

Purpose To report a case of bilateral anterior ischaemic optic neuropathy with macular star in a patient with Henoch–Schönlein purpura (HSP). Methods A 46‐year‐old man was referred to our clinic complaining of progressive decrease in visual acuity of the right eye (OD) since the last 10 days, and since 3 days in his left eye (OS). His visual acuity was ‘hand motion’ OD and 4/10 OS. Anterior segment examination was insignificant, while fundus examination revealed optic disc edema, and bilateral macular star. A relative afferent pupillary defect was present in his right eye with normal pupillary reflexes in the left eye. Laboratory analysis showed: Hematocrit: 22.1%, ESR: 140 mm/hr, CRP: 64.80 mg/dl, Creatinine: 4.4 mg/dl. Physical examination revealed presence of erythematous rash on the trunk and the extremities. The patient was admitted to the Nephrology department for treatment of his azotemia. Results During his hospital course we performed complete laboratory and imaging examinations for autoimmune diseases, vasculitis and infectious diseases, which were negative. Histologic findings of renal biopsy were compatible with IgA glomerulonephritis and thus HSP was diagnosed. The patient received oral methylprednisolone and intravenous cyclophosphamide therapy. Six months later his renal function had improved, the rash had subsided and his visual acuity was ‘counting fingers’ OD and 10/10 OS. Standard automated perimetry showed peripheral visual field depression bilaterally. Conclusions Henoch–Schönlein purpura (HSP) is a small vessel vasculitis which is more common in children. Based on literature, ophthalmic manifestations of HSP usually involve the anterior segment and less frequently the posterior segment. Systemic vasculitis should be included in the differential diagnosis of bilateral optic disc edema.