Sudden vision loss needs same-day care. If you are over 50 and also have a new headache, jaw pain when chewing, or scalp tenderness, go to the emergency department.

For patients and families

What it is

PION is a rare condition in which the back part of the optic nerve, behind the eye, does not get enough blood.¹ Unlike NAION, the front of the nerve looks normal at first, so other tests are needed to make the diagnosis.¹

When it happens

• After some surgeries, especially long spine surgeries done face-down and some heart surgeries, usually related to low blood pressure, blood loss, or swelling during the operation²
• With giant cell arteritis, which is an emergency (see Giant cell arteritis)¹
• Less often with other blood vessel or blood pressure problems¹

What to do

Vision loss noticed on waking after surgery should be reported right away. If you are planning a long spine surgery, your surgical and anesthesia team can talk with you about this rare risk.²

For clinicians

• Types (Hayreh): perioperative (surgical), arteritic (GCA), and non-arteritic PION.¹
• Presentation: acute loss of acuity and/or field with RAPD (if unilateral) and a normal disc acutely, with pallor developing over weeks.¹ It is a diagnosis of exclusion: obtain MRI of the brain and orbits (diffusion-weighted imaging of the optic nerve may show restriction) to exclude compressive, inflammatory, and infiltrative lesions.
• Always exclude GCA in patients over 50 (ESR, CRP, platelets), and treat empirically if suspected.¹
• Perioperative visual loss: the ASA practice advisory for spine surgery addresses high-risk patients, positioning, blood pressure and hemoglobin management, fluid management, and consideration of staged procedures.²
• Relevance to NAION: both are ischemic optic neuropathies; systemic hypotension is a shared theme in proposed mechanisms.³ See the NAION risk factors page.

References

1. Hayreh SS. Posterior ischaemic optic neuropathy: clinical features, pathogenesis, and management. Eye (Lond). 2004;18(11):1188-1206. https://pubmed.ncbi.nlm.nih.gov/15534605/
2. American Society of Anesthesiologists Task Force on Perioperative Visual Loss, et al. Practice Advisory for Perioperative Visual Loss Associated with Spine Surgery 2019. Anesthesiology. 2019;130(1):12-30. https://pubmed.ncbi.nlm.nih.gov/30531555/
3. Biousse V, Newman NJ. Ischemic Optic Neuropathies. N Engl J Med. 2015;372(25):2428-2436. https://pubmed.ncbi.nlm.nih.gov/26083207/
4. EyeWiki (American Academy of Ophthalmology). Posterior Ischemic Optic Neuropathy. https://eyewiki.org/Posterior_Ischemic_Optic_Neuropathy

How to reach us

Hazleton Eye Specialists: phone 570-453-2020, fax 570-453-1020. Addresses for all five offices (Hazleton, Stroudsburg, Nanticoke, Pottsville, and Bangor) are on Find an Eye Doctor.

Sudden vision loss needs same-day care. Call an eye doctor right away. If you also have a new headache, jaw pain when chewing, scalp tenderness, fever, or you are over 50 and feel unwell, go to the emergency department.

Medical disclaimer. This page is for general education. The patient section is not medical advice, and the clinician section is not a clinical practice guideline; neither replaces an examination, clinical judgment, or specialty consultation. If you have sudden vision loss, seek same-day care from an eye doctor or an emergency department. Information is current as of the “last reviewed” date.