Howard Pomeranz, M.D., Ph.D | Massachusetts Eye and Ear Infirmary, Harvard Medical School, University of Maryland Medical Center M.A. Afshari, M.D., M.P.H. | Massachusetts Eye and Ear Infirmary, Harvard Medical School
A 56 year-old white man complained of blurring of the lower one-third of the vision in his left eye for the past five days. His past ocular history was significant only for retinoschisis bilaterally which was diagnosed three years previously. He has been treated for hypertension for six years with amlodipine. He denied headache, eye pain or diplopia. Visual acuities were 20/20 bilaterally. Color vision was normal. A left afferent pupillary defect was present. A left inferior altitudinal defect was present. Optic nerves are illustrated below. The ESR was 17. The hematocrit was 49.4%.
1. What is the diagnosis? Answer: The photographs demonstrate a normal appearing right optic nerve with a small cup to disk ratio. The left optic nerve is edematous with several flame hemorrhages in the nerve fiber layer and on the optic nerve head. The ophthalmic history and findings are suggestive of nonarteritic anterior ischemic optic neuropathy.