A Case Report of Sudden Painless Vision Loss

Introduction Non-arteritic anterior ischemic optic neuropathy (NAION) is characterized by acute monocular vision loss due to ischemia in the optic nerve caused by impaired circulation in the short posterior ciliary arteries [1]. Risk factors include systemic conditions such as hypertension, diabetes, hyperlipidemia, and local anatomical predispositions like small optic disc size [2]. Case Presentation A 56-year-old woman presented with sudden, painless left eye vision loss lasting for one week. She reported blurred vision but no other ocular or systemic symptoms. Medical history included hyperlipidemia and hypertension. Best corrected visual acuity (Snellen chart, Landolt C optotype) was 1.0 in both eyes, but perimetry showed incomplete inferior altitudinal field defects in the left eye, with a left relative afferent pupillary defect. Fundoscopy showed optic disc swelling and retinal vascular narrowing in the left eye. Optical coherence tomography (OCT) revealed optic disc swelling. Laboratory tests were normal, temporal artery ultrasound (TAUS) showed no arteritis, computed tomography and magnetic resonance imaging excluded brain pathology. The patient was referred to neurologist and cardiologist consultations. There was no ophthalmological treatment added. Risk factors such as hyperlipidemia and arterial hypertension have been controlled. Discussion Sudden painless visual loss can be caused by various pathologies – ischemic optic neuropathies, retinal artery occlusion, retinal vein occlusion, retinal detachment, vitreous hemorrhage, cerebral infarction etc. [1]. If patient is suspected with ischemic optic neuropathy, arteritic AION must be excluded [3]. This patient denied any symptoms of jaw claudication or scalp tenderness, ESR and C-reactive protein were not elevated, TAUS was negative for arteritis [4]. Arteritic AION typically causes more severe vision loss, whereas NAION usually presents with segmental optic disc edema. This case was unusual due to diffuse disk edema [3]. NAION lacks proven treatment; management focuses on controlling vascular risk factors [1]. Conclusions Sudden painless visual loss requires urgent ophthalmological examination. In many cases, a diagnosis can be made based on history and examination. Vascular risk factors significantly increase NAION risk [1].