J Korean Ophthalmol Soc.  2014 Jan;55(1):161-166.

Bilateral Anterior Ischemic Optic Neuropathy after Gastrointestinal Bleeding

• Ko JS
• Kim GA
• Shin JY
• Byeon SH

Abstract

PURPOSE
To introduce a case of bilateral anterior ischemic optic neuropathy (AION) after blood loss due to gastrointestinal bleeding.
CASE SUMMARY
A 50-year-old male patient with a history of type 1 diabetes mellitus and alcoholic liver cirrhosis presented with 3 days of melena and 1 day of general weakness and dizziness. Initial hemoglobin level was 4.7 g/dL and blood pressure was 100/55 mm Hg. On esophagogastroduodenoscopy, a peptic ulcer with evident recent bleeding was observed. After transfusion of packed red blood cells and endoscopic hemostasis of bleeding, his general condition improved but he complained of blurred vision in both eyes which developed immediately after the onset of melena. Initial best-corrected visual acuity (BCVA) was 0.5 in his right eye and 0.6 in the left eye. On fundus examination, swollen optic disc with blurred margin was noted and he had constricted visual fields. On follow-up, the patient received posterior subtenon triamcinolone injection in his right eye. After the procedure, the BCVA was improved to 0.8 in both eyes, but he still had bilateral pale optic disc with constricted visual field.
CONCLUSIONS
In the case of visual loss after recent blood loss, AION should be considered as a diagnosis, which can present as bilateral involvement.

Keyword

Acute blood loss; Bilateral anterior ischemic optic neuropathy

MeSH Terms

Blood Pressure
Diabetes Mellitus, Type 1
Diagnosis
Dizziness
Endoscopy, Digestive System
Erythrocytes
Follow-Up Studies
Hemorrhage*
Hemostasis, Endoscopic
Humans
Liver Cirrhosis, Alcoholic
Male
Melena
Middle Aged
Optic Neuropathy, Ischemic*
Peptic Ulcer
Triamcinolone
Visual Acuity
Visual Fields
Triamcinolone

Figure

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  Figure 1. Bilateral disc swelling with blurred margin is noted in both eyes. Cotton wool spots near disc are also noted. Please note the sectoral spared optic disc swelling in the superonasal quadrant on the right eye.

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  Figure 2. Late phase bilateral optic disc leaking are noted on fluorescein angiography of the right (A) and left (B) optic disc.

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  Figure 3. Automated perimetry (Humphrey 30-2) at initial visit shows superior altitudinal and inferior arcuate defect in the right (A) and left (B) eyes.

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  Figure 4. 2 months after the attack of bilateral anterior ischemic optic neuropathy, the optic disc swellings were resolved and the discs became pallor. (A) Automated perimetry (Humphrey 30-2) after 2 months shows superior altitudinal and inferior arcuate defects in both eyes. (B) There were markedly improved results in comparison with initial findings.

Reference

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