Non‐arteritic anterior ischemic optic neuropathy due to hypovolemia

Abstract

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.