Anterior optic neuropathy

Ophthalmic examination showed anterior optic neuropathy in all three patients and MRI scanning ruled out demyelinating optic neuritis. In one patient an additional infusion of infliximab produced similar symptoms in the previously unaffected eye vision failed to improve despite infliximab withdrawal and steroid treatment. 

Sensory systems Vision A 68-year-old man with Crohn s esophagitis developed acute bilateral visual loss due to bilateral anterior optic neuropathy during a third infusion of infliximab [47 ]. Completely reversible bilateral optic neuritis associated with multiple sclerosis in a patient with Crohn s disease and sacroiliitis receiving infliximab induction therapy has also been reported [48 ]. 

Nervous system Bilateral anterior optic neuropathy has been reported in an otherwise healthy 43-year-old man who took terbinafine 500 mg/day for onychomycosis [1" ]. Terbinafine was withdrawn and his visual acuity improved considerably within 1 month, but there was slight pallor of the left optic disc and the visual fields of both eyes were still concentrically constricted. One plausible explanation for this effect of terbinafine may be that it is amphiphilic, which may allow binding to polar lipids and accumulation within lysosomes. Drug-induced lysosomal impairment has been presumed to be the basis of the retinal changes observed with other amphiphilic drugs, such as amiodarone, perhexilene, and suramin. 

Yulek F, Cagil N, Cakmak HB, Ak ay EK, Simsek S, Kansu T. Bilateral anterior optic neuropathy associated with use of terbinafine. Clin Exp Ophthalmol 2008 36 488-9. 

Nonarteritic anterior ischemic optic neuropathy (NAION)... 

Fraunfelder FW, Pomeranz HD, Egan FLA. Non-arteritic anterior ischaemic optic neuropathy and sildenafil. Arch Ophthamol 2006 124 733-734. 

SLE is a multisystem, idiopathic, autoimmime disease characterized by infiltration of capillaries of collagen-vascular tissue by antibody-antigen complexes.The optic disc in SLE can be elevated, and there may be a painless reduction in visual acuity. SLE optic neittopathy may present as either a retrobulbar optic neittopathy or as an anterior ischemic optic neuropathy (AION). 

Recent CT and MRI studies showed that increased extraocular muscle volume correlates with compressive optic neuropathy as well. Although some patients show inflammation of the nerve and sheath, it has been postulated that these patients have shallow orbits or that they lack the ability to decompress anteriorly. Patients at greater risk of developing optic neuropathy are older patients with enlarged extraocular muscles and limited motility. Diabetic patients with proptosis and extraocular muscle enlargement are also more likely to develop optic neuropathy. 

Hayreh SS. Erectile dysfunction drugs and non-arteritic anterior ischemic optic neuropathy is there a cause and effect relationship J Neuroophthaknol 2005 25 295-298. 

Possible" effects (all possibly due to the associated activity and not the drug) mydriasis, retinal vascular accidents, subconjunctival hemorrhages, anterior ischemic optic neuropathy (NAION), central serous chorioretinopathy (CSCR)... 

Primary open-angle glaucoma (POAG) is a multifactorial chronic optic neuropathy with a characteristic acquired loss of optic nerve fibers. Cupping and atrophy of the optic disc occur in the absence of other known causes. Such damage develops in the presence of open anterior chamber angles. It produces characteristic visual field abnormalities. lOP is too high for the continued health of the eye. 

Other rare forms of neuropathy (SED-13,1092) include mononeuropathy multiplex (52), acute axonal polyneuropathy (53), anterior ischemic optic neuropathy (54), trigeminal sensory neuropathy (55), bilateral neuralgic amyotrophy (56), brachial plexopathy (57), and symptoms suggestive of leukoencephalopathy (58). 

A 60-year-old smoker was treated with interferon alfa (100 MU/week for 2 months and 9 MU/week for 15 weeks) for cutaneous melanoma. Ocular examination was normal before treatment, but he developed acute loss of peripheral vision in his left eye after 23 weeks. Examination was consistent with anterior ischemic optic neuropathy, and there was optic disc edema, a pupillary defect, and circular visual field constriction in the left eye. There was renal artery constriction in both eyes. Despite treatment with aspirin, high-dose dexamethasone, heparin, and finally withdrawal of interferon alfa, loss of visual function progressed and affected both eyes. Ciclosporin was started, but he was considered to have irreversible loss of visual function. 

Purvin VA. Anterior ischemic optic neuropathy secondary to interferon alfa. Arch Ophthalmol 1995 113(8) 1041. ... 

Gupta R, Singh S, Tang R, Blackwell TA, Schiffman JS. Anterior ischemic optic neuropathy caused by interferon alpha therapy. Am J Med 2002 112(8) 683. ... 

Fivgas GD, Newman NJ. Anterior ischemic optic neuropathy following the use of a nasal decongestant. Am J Ophthalmol 1999 127(l) 104-6. 

A 42-year-old man presented with anterior ischemic optic neuropathy, leading to a visual field defect in that eye within 24 hours of having taken sildenafil (25). 

Anterior ischemic optic neuropathy is a disorder whose pathophysiology is poorly understood. The difference between the intraocular pressure and the perfusion pressure in the posterior ciliary arteries determines the circulation in the optic disc, and a reduction in this difference may contribute to ischemia. 

Egan R, Pomeranz H. Sildenafil (Viagra) associated anterior ischemic optic neuropathy. Arch Ophthalmol 2000 118(2) 291-2. 

Pomeranz HD, Smith KH, Hart WM Jr, Egan RA. Sildenafil-associated nonarteritic anterior ischemic optic neuropathy. Ophthalmology 2002 109(3) 584-7. 

Hammer ME, Burch TG. Viscous corneal protection by sodium hyaluronate, chondroitin sulfate, and methylcellulose. Invest Ophthalmol Vis Sci 1984 25 1329-1332 Harrison SE, Soil DB, Shayegan M. Clinch T. Chondroitin sulfate a new and effective protective agent for intraocular lens insertion. Ophthalmology 1982 89 1254-1260 Hayreh SS. Anterior ischemic optic neuropathy. Occurrence after cataract extraction. Arch Ophthalmol 1980 98 1410-1416... 

Non-arteritic anterior ischemic optic neuropathy has been reported after intravitreal injection of bevacizumab for treatment of angjoid streaks in pseudoxanthoma elasti-cum [6 ]. 

Ganssauge M, Wilhelm H, Bartz-Schmidt KU, Aisenbrey S. Non-arteritic anterior ischemic optic neuropathy (NA-AION) after intravitreal injection of bevacizumab (Avastin) for treatment of angoid streaks in pseudoxanthoma elasticum. Graefes Arch Clin Exp Ophthalmol 2009 247(12) 1707-10. 

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