Acute Unilateral Vision Loss in a 61-Year-Old Woman: Distinguishing Non-arteritic Anterior Ischemic Optic Neuropathy (NAION) From Optic Neuritis and Papilledema.

Within the population over age 50, non-arteritic anterior ischemic optic neuropathy (NAION) represents a primary etiology for acute, unilateral visual impairment. It shares common features with conditions like optic neuritis and papilledema, making accurate diagnosis difficult. A 61-year-old woman came to AKFA Medline University Hospital with sudden, painless vision loss in her left eye that began four days prior. Her medical history included high blood pressure. An eye examination revealed swelling of the optic disc with blurred edges and decreased vision in her left eye. Evaluation via optical coherence tomography (OCT) revealed prominent edema within the retinal nerve fiber layer, indicating involvement of the acute optic nerve head. A magnetic resonance imaging scan of the brain and orbits ruled out intracranial problems and demyelinating diseases. Laboratory results indicated that the erythrocyte sedimentation rate (ESR) did not deviate from normal limits; however, a marginal rise in C-reactive protein was noted, with no clinical evidence to support a diagnosis of systemic vasculitis or giant cell arteritis. Considering her clinical presentation, imaging results, and the exclusion of other potential causes, a diagnosis of non-arteritic anterior ischemic optic neuropathy was established. She received conservative treatment focused on controlling vascular risk factors, and follow-up visits showed stable vision with some improvement in optic disc swelling. This case emphasizes the need for a thorough diagnostic method that combines clinical evaluation, imaging, and lab tests. This approach is crucial for distinguishing NAION from other causes of acute optic disc edema, helping to prevent misdiagnosis and improper treatment.