CONCURRENT BILATERAL NON-ARTERITIC ANTERIOR ISCHEMIC OPTIC NEUROPATHY (NAION) IN PATIENT WITH PRE-EXISTING OPTIC ATROPHY: A CASE REPORT

Non-arteritic anterior ischemic optic neuropathy (NAION) is one of the most common forms of ischemic optic neuropathy, often presenting with sudden vision loss and visual field defects. However, bilateral simultaneous NAION is exceedingly rare. We describe a case of a 32-year-old Malay lady with a known history of bilateral papilledema secondary to idiopathic intracranial hypertension (IIH), diabetes mellitus, hypertension and end-stage renal failure (ESRF), who presented with a three-day history of painless, bilateral vision loss. Notably, her optic nerve function had previously been normal, and there were no recent traumatic events, elevated intraocular pressure (IOP) symptoms, neurological deficits, or recent infections. On examination, her visual acuity (VA) was reduced to perception of light (PL) in the right eye and counting fingers (CF) in the left eye. She had a right relative afferent pupillary defect (RAPD). Anterior segment examinations were unremarkable bilaterally, while fundus examination showed pale optic discs with blurred margins in both eyes. Other retinal findings were unremarkable. Infectious, autoimmune, and demyelinating workups were negative. Neuroimaging and lumbar puncture results were also normal. In conclusion, this case highlights that chronic systemic conditions may increase the risk of developing NAION, in addition to any pre-existing ocular comorbidity. Currently, there is no definitive treatment for NAION, emphasizing the importance of optimizing all contributing factors to prevent further optic nerve damage and vision loss.

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