[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Non-arteritic anterior ischaemic optic neuropathy

# Non-arteritic anterior ischaemic optic neuropathy

A painless stroke of the [optic nerve](https://durgical.com/en/anatomy/optic-nerve/) head, often noticed on waking, in people over 50 with vascular risk. Giant cell arteritis is excluded the same day.

Updated Nov 5, 2026

On this page

- The basics What it is
- Who gets it
- Causes
- Risk factors
- Pathophysiology
- Why it happens
- In anaesthesia

- Clinical Symptoms and signs
- Red flags
- Diagnosis
- Differential diagnosis
- Complications
- Prognosis

- Treatment Goal of treatment
- Treatment

- Study Test yourself

- Connections Connections

## What it is

Sudden painless loss of vision in one eye from poor flow in the short posterior ciliary arteries that supply the optic nerve head, usually in a small, crowded disc. It is the most common acute optic neuropathy after 50; the key is to tell it from the arteritic form, which needs urgent corticosteroids.

See it in 3D

- [Optic disc](https://durgical.com/en/anatomy/optic-disc/)
- [Optic nerve](https://durgical.com/en/anatomy/optic-nerve/)
- [Ophthalmic artery](https://durgical.com/en/anatomy/ophthalmic-artery/)

## Who gets it

Most common acute optic neuropathy after 50; vascular risk factors are frequent.

## Causes

- Hypoperfusion of the optic nerve head in a small, crowded disc
- Nocturnal hypotension

## Risk factors

- Small [optic disc](https://durgical.com/en/anatomy/optic-disc/) with little or no cup
- Hypertension, diabetes and dyslipidaemia
- Obstructive sleep apnoea
- Nocturnal hypotension, including from over-treated blood pressure
- Phosphodiesterase-5 inhibitors (association reported)

## Pathophysiology

In a crowded disc, a drop in perfusion causes ischaemia and swelling of the axons; the swelling compresses neighbouring axons in the tight scleral canal, worsening the damage.

## Symptoms and signs

- Sudden painless loss of vision or of the upper or lower half of the field in one eye
- Often noticed on waking
- Reduced colour vision

## Red flags

- Headache, jaw claudication, scalp tenderness or raised ESR and CRP: arteritic form
- Bilateral or progressive loss
- Pain on eye movement (optic neuritis)

## Diagnosis

**Clinical**
Afferent pupillary defect, altitudinal field defect and a swollen, often segmental disc with nearby haemorrhages; the other eye usually shows a small disc without a cup.

**Tests**
ESR, CRP and blood count the same day to exclude giant cell arteritis; glucose, lipids and assessment for sleep apnoea.

**Imaging**
Brain and orbit MRI if the presentation is atypical.

## Differential diagnosis

- Arteritic ischaemic optic neuropathy
- Optic neuritis
- Compressive optic neuropathy
- Papilloedema

## Goal of treatment

Exclude giant cell arteritis, control vascular risk factors and protect the other eye.

## Treatment

**Medical**
Control of blood pressure (avoiding night-time hypotension), glucose and lipids.

**Follow-up**
Ophthalmology follow-up of visual function and of the other eye.

**Lifestyle**
Assessment and treatment of sleep apnoea.

## Complications

- Permanent visual field loss and optic atrophy
- Involvement of the other eye in a minority of patients

## Prognosis

Visual loss is usually permanent, with modest improvement in some patients; no treatment has proved to restore vision.

## Test yourself

Think of the answer, then tap the question to see it.

## Which disease must be excluded the same day in ischaemic optic neuropathy?

Giant cell arteritis, with ESR, CRP and blood count.

## What disc anatomy predisposes to the non-arteritic form?

A small, crowded optic disc with little or no cup.

## When is the visual loss often noticed?

On waking, consistent with nocturnal hypotension.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/conditions/non-arteritic-anterior-ischaemic-optic-neuropathy/)

## Why it happens

- [Optic neuropathies](https://durgical.com/en/general-pathology/optic-neuropathies/)

## In anaesthesia

- [Positioning and its injuries](https://durgical.com/en/anaesthesia/positioning-and-its-injuries/)

## Connections

## Related conditions 4

- [Giant cell arteritis](https://durgical.com/en/conditions/giant-cell-arteritis/)
- [Arterial hypertension](https://durgical.com/en/conditions/arterial-hypertension/)
- [Type 2 diabetes mellitus](https://durgical.com/en/conditions/type-2-diabetes-mellitus/)
- [Obstructive sleep apnoea](https://durgical.com/en/conditions/obstructive-sleep-apnoea/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Nonarteritic Anterior Ischemic Optic Neuropathy](https://www.ncbi.nlm.nih.gov/books/NBK559045/) (StatPearls Publishing (NCBI Bookshelf), 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/non-arteritic-anterior-ischaemic-optic-neuropathy/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/non-arteritic-anterior-ischaemic-optic-neuropathy/