Anterior Ischemic Optic Neuropathy Associated with Acute Severe Anemia Due to Myelodysplastic Syndrome (MDS): A Case Report

A 73-year-old male with cardio-vascular risk factors and myelodysplastic syndrome presented with first event of acute painless altitudinal vision loss in the left eye, accompanied by bilateral optic disk swelling. Neuro-ophthalmologic examination revealed afferent disturbances, including a positive relative afferent pupillary defect. Laboratory tests showed normocytic anemia with hemoglobin level of 5.9 g/dL, erythrocyte sedimentation rate (ESR) of 75 mm/h and a c-reactive protein level (CRP) of 0.46 mg/dl. Other lab results were unremarkable. A thorough workup ruled out differential diagnoses such as: increased intracranial pressure, giant cell arteritis and optic neuropathy due to leukemic transformation. Two months later, a recurrent episode of acute painless altitudinal vision loss in the right eye accompanied by a recurrence of severe anemia led us to the most probable diagnosis: anterior ischemic optic neuropathy associated with acute severe anemia.