scholarly journals Nonarteritic Anterior Ischemic Optic Neuropathy following Herpes Zoster Ophthalmicus and Steroid-Related Intraocular Pressure Spike

2021 ◽  
pp. 11-15
Author(s):  
Po Hsiang Yuan ◽  
Jonathan A. Micieli
Keyword(s):  
Intraocular Pressure ◽  
Herpes Zoster ◽  
Optic Neuropathy ◽  
Temporal Relationship ◽  
Vision Loss ◽  
Anterior Ischemic Optic Neuropathy ◽  
Topical Steroids ◽  
Ischemic Optic Neuropathy ◽  
Herpes Zoster Ophthalmicus ◽  
Varicella Zoster

A 61-year-old woman presented with sudden vision loss from a left anterior optic neuropathy in the context of severely elevated intraocular pressure after starting topical steroids for anterior uveitis related to herpes zoster ophthalmicus (HZO). The strong temporal relationship between the vision loss and elevated IOP suggested the vision loss was related to nonarteritic anterior ischemic optic neuropathy (NAION). Anterior chamber paracentesis did not detect varicella zoster virus (VZV) and magnetic resonance imaging of the orbits was normal. Her vision remained stable and the optic disc edema resolved within 3 months. The occurrence of NAION following an acute elevation of intraocular pressure (IOP) is well-documented in the context of surgical procedures, glaucoma, uveitis and trauma. This case indicates that not every optic neuropathy in close temporal relationship with HZO is directly attributable to the virus. NAION may also occur after steroid-related IOP spikes and ophthalmologists should ensure that patients on topical steroids are closely monitored for ocular complications.

scholarly journals Herpes Zoster Anterior Uveitis with Hyphaema

2021 ◽  
Vol 3 (5) ◽  
pp. 1-3
Author(s):  
Rajagopal Arvinth ◽  
Mimiwati Zahari ◽  
Sagili Chandrasekhara Reddy
Keyword(s):  
Herpes Zoster ◽  
Anterior Uveitis ◽  
Vision Loss ◽  
Topical Steroids ◽  
Herpes Zoster Ophthalmicus ◽  
Early Referral ◽  
Varicella Zoster ◽  
Ocular Manifestations ◽  
Detailed Evaluation ◽  
Varicella Zoster Infection

Herpes zoster ophthalmicus usually manifests in elderly people as a unilateral painful skin rash in a dermatomal distribution of the ophthalmic division of the trigeminal nerve shared by the eye and ocular adnexa. It is the reactivation of varicella-zoster infection. Most common ocular manifestations of this disease include keratitis, conjunctivitis, and anterior uveitis. Severe hyphemia as a complication following herpes zoster uveitis is uncommon. We report a rare case of a 90-year-old lady with herpes zoster ophthalmicus and diabetes mellitus with unusually severe hyphemia. The disease responded well to systemic and topical steroids with improved vision outcome. Early referral to an ophthalmologist, detailed evaluation, and immediate treatment are mandatory to prevent permanent vision loss in these patients.

scholarly journals Protective effects of quercetin in a rodent model of anterior ischemic optic neuropathy (rAION)

2019 ◽  
Author(s):  
Ya-nan Lyu ◽  
Jing-yu Min ◽  
Yuanyuan Gong ◽  
qing Gu ◽  
fang Wei
Keyword(s):  
Intravitreal Injection ◽  
Optic Neuropathy ◽  
Vision Loss ◽  
Ganglion Cells ◽  
Rodent Model ◽  
Anterior Ischemic Optic Neuropathy ◽  
Ischemic Optic Neuropathy ◽  
Protective Effects ◽  
High Power Field ◽  
Optic Nerves

Abstract Background: Anterior ischemic optic neuropathy (AION) is the leading cause of sudden optic nerve-related (ON-related) vision loss in elderly people. However, no considerable treatments are available for the neuroprotection of NAION. The purpose of this study was to detect the effects of intravitreal injection of quercetin (Qcn) in a rodent model of anterior ischemic optic neuropathy (rAION). Methods: The rAION model was established using verteporfin and laser in a photodynamic procedure on the optic discs (ON) of rats. The rats received intravitreal injection of Qcn 2 days before the injury and once/week for 4 weeks after the infarct on optic neuropathy. Flash-visual evoked potential (VEP) were recorded to assess the visual function. TUNEL and retrograde Fluorogold labeling assessed the apoptosis and density of retinal ganglion cells (RGCs). ED-1 and Iba-1 staining of the optic nerves displayed the inflammatory response. Results: At 14 days post-infarct, Qcn treatment significantly reduced the number of apoptotic RGCs, as well as, ED1/Iba-1-positive cells/high power field(HPF) in the ON (p<0.01) as compared to the rAION group. At week 4 after rAION, 28.4% VEP amplitudes were estimated in the treated eyes of the fellow eyes in the rAION group and 64.7% in the rAION+Qcn group (p<0.01). In addition, Qcn saved the RGCs in the central retinas as compared to those of the rAION group (1967.5±162.1 and 2868±325.3 mm2, respectively (p<0.01), and the corresponding densities were 1654.8±104.8 and 2208±272.9 mm2 in the mid-peripheral retinas, respectively (p<0.01). Conclusion: The intravitreal injection of Qcn could protect the RGCs from injury in the rAION animal model, as demonstrated anatomically by RGC density and functionally by F-VEP. Moreover, Qcn might exert an anti-apoptosis role in the survival of RGCs and anti-inflammatory in the optic nerves.

scholarly journals Clinical and ultrasonographic features in anterior ischemic optic neuropathy

2018 ◽  
Vol 75 (8) ◽  
pp. 773-779
Author(s):  
Dragos Jianu ◽  
Nina Jianu ◽  
Mihnea Munteanu ◽  
Ligia Petrica
Keyword(s):  
Optic Neuropathy ◽  
Vision Loss ◽  
Clinical Symptoms ◽  
Color Doppler ◽  
Resistance Index ◽  
Doppler Imaging ◽  
Anterior Ischemic Optic Neuropathy ◽  
Ischemic Optic Neuropathy ◽  
Dark Halo ◽  
Ciliary Arteries

Background/Aim. Anterior ischemic optic neuropathy (AION) represent a segmental infarction of the optic nerve head which is supplied by the posterior ciliary arteries. There are two types of AION: non-arteritic (NAAION and arteritic (A-AION), due to giant cell arteritis (GCA). The aim of this study was to investigate the clinical features and ultrasound characteristics of the orbital vessels and superficial temporal and carotid arteries, in patients with unilateral acute AION in order to help differentiate newly diagnosed NA-AION from AAION. Methods. In this prospective comparative, observational study, 62 consecutive patients with clinical suspicion of unilateral acute AION were examined at admission and in the first two months of evolution, following a protocol including color Doppler imaging (CDI) of the orbital vessels. Results. We found 12 patients with A-AION, all of them with biopsy-confirmed disease, and 50 patients with NA-AION. A-AION patients presented a combination of a history of amaurosis fugax before acute, painless, and severe vision loss in the affected eye, and a diffuse pale optic disc edema. In these patients, CDI of the orbital vessels indicated high resistance index (RI), with severe diminished blood flow velocities in all orbital vessels, in both orbits. In the NAAION patients, none of these clinical symptoms were found and blood velocities and RI in posterior ciliary arteries were preserved. Typical sonographic feature in temporal arteritis as part of GCA was the ?dark halo? sign. Conclusions. The ultrasound investigations enable prompt differentiation between NA-AION and A-AION.

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