What Are the Treatments for Ischemic Optic Neuropathy?


Optic neuropathy is some type of damage to the optic nerve. Ischemic optic neuropathy refers specifically to damage due to a restriction of the optic nerve's blood supply. The most common symptom is a gradual loss of vision and swelling of the optic disc. The treatments may generally be classified into surgical and medical options.

Surgical Treatment

  • The most common surgery for anterior ischemic optic neuropathy is decompression of the optic nerve. The use of this treatment in actually improving the patient's vision is controversial, but it also allows for a biopsy to be taken of the temporal artery. This biopsy is necessary to diagnose arteritis as the cause of the neuropathy.

    A consultation with a rheumatologist will be needed to make a diagnosis of giant cell arteritis. This condition may also require consultations with additional specialists as giant cell arteritis affects many different systems.

Medical Treatment

  • Steroids are the most common medical treatment for the underlying conditions of ischemic optic neuropathy. However, they will do little to restore the vision that has already been lost. Ischemic optic neuropathy is associated with additional conditions, such as diabetes and high blood pressure, which have their own specific treatments.

    Ischemic optic neuropathy may be treated with prednisone in dosages that decrease over time. For example, a typical steroid therapy might consist of an initial dosage of 60 milligrams per day (mg/d) that is reduced by 10 mg for each 2-week period until the dosage reaches 40 mg/d. This dosage is then maintained for an additional 2 weeks or more and then reduced another 5 mg/d every week or two. Once the dosage drops to 20 mg/d, the daily dosage is reduced by 2.5 mg every week or two until it decreases to 10 mg/d. The dosage is then reduced by 1 mg per month until it is discontinued entirely.

    The course of ischemic optic neuropathy should be monitored during the course of the steroid therapy. The reduction schedule may need to be delayed if there is a recurrence and the dosage may even need to be increased if there is a flare-up. Common tests for ischemic optic neuropathy include a monthly check of the patient's erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level.


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