Shock-induced non-arteritic anterior ischemic optic neuropathy (NAION). A case report.

Yi-Ching Lee, Ming-Muh Sheu, Rong-Kung Tsai

Tzu-Chi General Hospital, Hualien, Taiwan

Purpose: To describe a patient who developed shock-induced anterior ischemic optic neuropathy (SIAION) after profound gastrointestinal hemorrhage.

Methods: Retrospective, observational case report and literature review.

Results: A 46-year-old man was hospitalized for active duodenal and gastric ulcers, and received six units of packed red blood cells with adequate hydration after he was found to be severely anemic (Hb 6.1 g/dL) and dehydrated (blood glucose 586mg/dL; osmolarity 330 mmol/L). Sudden loss of vision in his right eye on the day of blood transfusion was noted by the patient. Neuro- ophthalmic examination 10 weeks later disclosed a relative pallor of upper optic disc in the right eye and a smaller cup disc ratio in the left eye. There's an inferior altitudinal visual field defect in the right eye. A diagnosis of SIAION secondary to anemia and impending hyperosmolar hyperglycemic state was made.

Conclusions: Our patient suddenly developed altitudinal visual field defect in the right eye after an episode of gastrointestinal hemorrhage. Hypovolemic shock can induce the development of NAION.