We report a case of a 32-year-old male who presents with a four days blurry vision in the left eye. Patient denied any associated pain or systemic symptoms. His review of system includes mild gastrointestinal discomfort 2 years prior that led to eventual removal of gallbladder. On initial work up, patient was found to have a visual acuity of 20/25- OD and 20/30+ OS. On slit lamp and fundus exam, patient was found to have marked edema of his left optic nerve. MRI of brain and orbits performed at that time showed questionable prechiasmatic enhancement of left optic nerve but did not explain marked swelling. Further work up with OCT revealed inferior thinning of the right ganglion cell layer and optic nerve fiber layer with edema of the left optic nerve. Humphrey visual field was significant for bilateral altitudinal defect. Patient was diagnosed with bilateral NAION.
NAION is known to be a disorder seen in patients greater than 50 years of age. For young patients with bilateral NAION, there is very little known if it represents a separate diagnostic and pathologic entity. While clinicians often pursue more extensive work up including hypercoaguability, there is little data that shows it could lead to change in management or if hypercoaguability itself is a risk factor for NAION. In our case, the patient did not have any positive lab work up and does not have any traditional risk factors of NAION. Further studies are needed to investigate other risk factors and to further understand the pathophysiology of NAION in order to prevent irreversible vision loss seen in cases of NAION.
Presentation Date: 12/05/2019
Issue Date: 08/01/2020