A Case of Shock-Induced Vision Loss

Lena A. Dixit, MD; Rod Foroozan, MD


August 15, 2014

Case Diagnosis

The correct diagnosis is nonarteritic anterior ischemic optic neuropathy (NAION). This man developed bilateral, acute visual loss with altitudinal and arcuate visual fields defects during an episode of severe symptomatic anemia owing to a duodenal ulcer. Although NAION is typically unilateral, when it occurs in the setting of acute anemia or hypertension, it can more commonly be bilateral and simultaneous.

Most patients with inflammatory optic neuropathy develop pain with eye movement and have enhancement of the involved optic nerve with contrast on MRI. The ESR was elevated; however, this can happen in the setting of severe anemia. Furthermore, this patient did not have any systemic symptoms or classic funduscopic signs to suggest arteritic anterior ischemic optic neuropathy.

Visual symptoms may occur with retinal vein occlusion before the onset of obvious peripheral retinal hemorrhages; however, this patient never developed any signs of retinopathy. There has been no documentation that visual function is better than claimed to suggest nonorganic vision loss, and the normal MRI helps exclude cortical vision loss.

Clinical Course

The clinical findings suggest shock-induced NAION secondary to severe anemia. On follow-up examination, the patient reported that the visual field defects were unchanged. Vision remained 20/20 in both eyes. Clinically, there was resolution of optic disc edema and subsequent development of mild sectoral pallor in each eye.


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