Treatment of Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION)

Acute Management

The American Academy of Ophthalmology suggests that unlike arteritic AION from giant cell arteritis, NAION has no level I data supporting any specific acute intervention, and various proposed treatments have failed to demonstrate consistent benefit in controlled studies 1
The American Academy of Ophthalmology recommends that the first priority is ruling out arteritic AION (giant cell arteritis), which is a true ophthalmologic emergency requiring immediate high-dose corticosteroids, and clinical indicators of GCA include temporal tenderness, jaw claudication, weight loss, proximal myalgia, or fever 2

The American Heart Association and American Academy of Ophthalmology suggest that patients with NAION should undergo urgent stroke workup, as NAION shares similar pathophysiology with other thromboembolic events, and evaluate for carotid stenosis, cardiac sources of emboli, and hypercoagulable states 1

The American Academy of Ophthalmology warns that never missing arteritic AION (GCA) is crucial, as delayed corticosteroid treatment leads to irreversible bilateral blindness, and systemic workup remains essential even in the lack of proven treatment for NAION 2
The American Academy of Ophthalmology advises against confusing the lack of proven treatment with lack of need for urgent evaluation, and emphasizes the importance of systemic workup 1

NAION is distinguished from arteritic anterior ischemic optic neuropathy (AION), which is caused by giant cell arteritis, according to the American Academy of Ophthalmology 3

The American College of Physicians recommends differentiating NAION from arteritic AION caused by giant cell arteritis, which requires urgent treatment, through diagnostic workup including complete ophthalmologic examination, visual field testing, ESR, and CRP 4, 5
The American Society of Anesthesiologists suggests that neuroimaging (CT or MRI) may be used to rule out other causes of visual loss in patients with suspected NAION 6, 7

The American Heart Association notes that PDE-5 inhibitors have been associated with NAION, though the evidence shows no statistically significant increased risk (relative risk 1.02 [95% CI, 0.92 to 1.12]), according to the Annals of Internal Medicine 8
The International Society of Travel Medicine reports that high-altitude travel has been associated with development of NAION in some cases 9
The American Society of Anesthesiologists states that in perioperative settings, NAION can occur as a rare complication (perioperative ION), particularly in spine surgeries 6, 7, 10