Progressive, Sequential Non-arteritic Anterior Ischemic Optic Neuropathy in the Context of Metabolic Syndrome and a Crowded Disc: A Case Highlighting Synergistic Vascular Risk

Non-arteritic anterior ischaemic optic neuropathy (NAION) is an ischaemic disorder involving the anterior portion of the optic nerve. It typically presents with acute, painless vision loss upon awakening, accompanied by optic disc oedema and an inferior altitudinal visual field defect. We report a 44-year-old woman with multiple metabolic risk factors, obstructive sleep apnoea, and an anatomically crowded optic disc, who developed progressive NAION followed by sequential involvement of the fellow eye, despite optimization of her risk factors.