Vasospasm-a risk factor for nonarteritic anterior ischemic optic neuropathy?

The cause of anterior ischemic optic neuropathy (AION) is thought to be occlusions of the posterior ciliary arteries, due to arteriosclerosis or emboli. The classical risk factors besides anatomical variants of the disc are those typically leading to arteriosclerosis. Whereas AION occurs mostly in elderly patients, it may also occur in young patients without relevant arteriosclerosis and even in the absence of risk factors. We report five young patients 12 to 44 years of age with typical AION. Extensive clinical and laboratory examination revealed no classical risk factors for arteriosclerosis. However, all patients had a vasospastic syndrome which included cold hands and feet, low blood pressure, migraine, and abnormal conjunctival vessels. The onset of symptoms under major stress, as well as the fast and relatively good recovery in most of the patients indicate that ischemia was due to local vasospasm in these young individuals.