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Posterior ischemic optic neuropathy

Authors
Madhura Tamhankar, MD
Nicholas J Volpe, MD
Section Editor
Paul W Brazis, MD
Deputy Editor
Janet L Wilterdink, MD

INTRODUCTION

Ischemic optic neuropathy is the most common optic nerve disorder in patients over age 50 years [1]. Ischemic optic neuropathy is generally categorized as anterior (affecting the optic disc) versus posterior (retrobulbar) and as arteritic versus nonarteritic. Posterior ischemic optic neuropathy (PION) is less common than anterior ischemic optic neuropathy.

PION is believed to result from an infarction of the retrobulbar optic nerve and is distinguished clinically from AION by a normal-appearing optic nerve head. As such, the diagnosis of PION can be somewhat more challenging than AION; PION must be distinguished from other causes of retrobulbar optic neuropathy as well as other causes of abrupt vision loss.

This topic discusses PION. Other forms of ischemic optic neuropathy and other optic neuropathies are discussed separately. (See "Nonarteritic anterior ischemic optic neuropathy: Epidemiology, pathogenesis, and etiologies" and "Clinical manifestations of giant cell (temporal) arteritis" and "Optic neuropathies".)

VASCULAR ANATOMY

The vascular supply of the retrobulbar optic nerve is distinct from that of the optic nerve head. (See "Nonarteritic anterior ischemic optic neuropathy: Epidemiology, pathogenesis, and etiologies", section on 'Vascular anatomy'.)

The posterior segment of the optic nerve is usually supplied by a pial capillary plexus that surrounds the nerve and is derived from collateral branches of the ophthalmic artery (figure 1) [2,3]. Most of the vascular supply is superficial; only a small number of capillaries penetrate the nerve and extend to its central portion, making this area somewhat poorly vascularized in comparison to its anterior portion. Because it is encased in the sphenoid optic canal, the early swelling that occurs after ischemic insult can lead to axonal compression further exacerbating optic nerve damage [4].

           

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Literature review current through: Nov 2016. | This topic last updated: Fri Nov 14 00:00:00 GMT 2014.
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