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      Preservation of Vision after Early Recognition of Anterior Ischemic Optic Neuropathy in a Patient with Sepsis


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          Non-arteritic ischemic optic neuropathy (NAION) can rarely occur in the setting of sudden vascular compromise, especially in patients with a “disk-at-risk” appearance. Anemia and hypotension are believed to be the main precipitators of shock-induced NAION. Early recognition of this phenomenon can prevent further visual loss and result in partial visual recovery. We here present a 56-year-old patient who developed NAION characterized by optic disc edema in both eyes and visual loss in the left eye secondary to hypotension in the setting of septic shock. He received aggressive blood pressure management (stopping all his anti-hypertensives, hydration, and midrodrine) which resulted in stabilization of vision in the right eye and likely prevented further visual loss in the left eye.

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          Most cited references7

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          Salvage of vision after hypotension-induced ischemic optic neuropathy.

          No effective treatment has been established for nonarteritic anterior ischemic optic neuropathy. Although most cases occur spontaneously, acute hypotension plays a clear role in a subset of patients. We examined three patients with severe visual loss from ischemic optic neuropathy induced by hypotension. The first patient developed anterior ischemic optic neuropathy after excessively rapid correction of malignant hypertension. In the second patient, anterior ischemic optic neuropathy occurred after an episode of orthostatic hypotension from systemic hypovolemia. The third patient developed anterior ischemic optic neuropathy after becoming hypotensive during a routine hemodialysis session. Measures were undertaken immediately to reverse the hypotension in all three patients. This intervention resulted in partial recovery of vision in each patient.
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            Anterior ischemic optic neuropathy: a complication after systemic inflammatory response syndrome.

            Patients are surviving previously fatal injuries. Unique morbidities are occurring in these survivors. Anterior ischemic optic neuropathy represents a previously unrecognized cause of blindness in the trauma victim. We hypothesize that this phenomenon is caused by unique characteristics of optic edema/ pressure or decreased blood flow associated with massive resuscitation. Between November of 1991 and August of 1998, there were 18,199 admissions to our trauma center. Of this group, 350 patients required massive volume resuscitation (>20 liters infused over first 24 hours). Patients having closed head injuries, facial fractures or direct orbital trauma were excluded from study. The following variables were studied: demographics, injury severity (Injury Severity Score, highest lactate, worst base deficit, and lowest pH) crystalloid and transfusion requirements, ventilator requirements (PEEP) RESULTS: Of the 350 patients with massive resuscitation, 9 patients were diagnosed with anterior ischemic optic neuropathy (2.6%). Of these, seven patients required celiotomy (78%). Six of the seven celiotomy patients had damage control celiotomies and abdominal compartment syndrome (86%). One patient had a repair of a subclavian artery; one had a complex acetabular repair. Blindness was unilateral in five patients and bilateral in four. All nine patients had evidence of global hypoperfusion, systemic inflammatory response, massive resuscitation, and high ventilatory support; one patient required cardiopulmonary resuscitation. Prone positioning is known to be associated with an increased intraocular pressure. We postulate that the combination of massive resuscitation and prone positioning will increase the incidence of anterior ischemic optic neuropathy. As such, we recommend that prone positioning for adult respiratory distress syndrome be reserved for only those patients at risk of death.
              • Record: found
              • Abstract: not found
              • Article: not found

              Blindness due to anterior ischemic optic neuropathy in a burn patient.


                Author and article information

                Case Rep Ophthalmol
                Case Rep Ophthalmol
                Case Reports in Ophthalmology
                S. Karger AG (Basel, Switzerland )
                12 July 2023
                Jan-Dec 2023
                12 July 2023
                : 14
                : 1
                : 314-318
                [a ]Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
                [b ]Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
                [c ]Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
                [d ]Kensington Vision and Research Centre, Toronto, ON, Canada
                [e ]Department of Ophthalmology, St. Michael’s Hospital, Unity Health, Toronto, ON, Canada
                Author notes
                Correspondence to: Jonathan A. Micieli, jmicieli@ 123456kensingtonhealth.org
                © 2023 The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ( http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.

                : 24 November 2022
                : 18 March 2023
                : 2023
                Page count
                Figures: 3, References: 7, Pages: 5
                There was no funding provided for this study.
                Case Report

                sepsis,optic neuropathy,shock-induced anterior ischemic optic neuropathy,non-arteritic ischemic optic neuropathy,early recognition,case report


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