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Diagnóstico diferencial entre glaucoma e neuropatia óptica isquémica anterior arterítica : a propósito de um caso clínico
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Introdução: A neuropatia óptica isquémica anterior arterítica (NOIA-A) e a neuropatia óptica glaucomatosa são patologias que podem cursar com perda irreversível da visão. A NOIA é uma patologia aguda que ocorre maioritariamente em pacientes mais velhos e é causada por inflamação e subsequente trombose das artérias ciliares curtas posteriores. Entre as etiologias prováveis destacam-se as vasculites do Sistema Nervoso Central. O glaucoma é uma neuropatia óptica progressiva caracterizada por alteração do anel neuroretiniano, perda de células ganglionares e seus axónios e subsequente defeito de campo visual. É essencial um estudo detalhado para um diagnóstico atempado e tratamento precoce. Caso clínico: Doente do sexo masculino, 58 anos, caucasiano, recorre à Consulta Externa de Oftalmologia do Centro Hospitalar Lisboa Norte em março de 2022 por escotoma no olho esquerdo (OE) com 3 meses de evolução. Ao exame oftalmológico de destacar melhor acuidade visual corrigida (AV) olho direito (OD): 10/10-; olho esquerdo (OE): 10/10-. A pressão intraocular (PIO) era de 20mmHg no OD e 24mmHg no OE. Objetivo: Resumir, esclarecer e compilar a informação disponível sobre a neuropatia óptica isquémica arterítica, com principal enfoque no seu diagnóstico diferencial com o glaucoma, visto que ambas são causas de escavação do disco óptico. Metodologia: Pesquisa da bibliografia relacionada com o tema via diversos motores de busca como PubMed, Google Scholar, Scielo e revistas de referência da área, utilizando como temas de pesquisa as seguintes expressões: arteritic anterior ischemic optic neuropathy, glaucoma, arteritic anterior ischemic optic neuropathy differential diagnosis, CNS vasculitis, optic disc cupping. Conclusão: O principal desafio do caso clínico foi o facto de o doente apresentar sintomatologia e exames concordantes com o diagnóstico de glaucoma atípico, tendo apenas uma observação completa e sistémica do doente contraditado este diagnóstico.
Introduction: Anterior ischemic optic neuropathy (AION) and glaucomatous optic neuropathy are pathologies that can lead to irreversible vision loss. AION is an acute condition that predominantly occurs in older patients and is caused by inflammation and subsequent thrombosis of the posterior short ciliary arteries. Possible etiologies include vasculitis of the central nervous system. Glaucoma is a progressive optic neuropathy characterized by alterations in the neuroretinal rim, loss of ganglion cells and their axons, and subsequent visual field defects. A thorough study is essential for timely diagnosis and early treatment. Case report: A 58-year-old Caucasian male patient presented to the Ophthalmology Outpatient Clinic of the North Lisbon University Hospital in March 2022 with a 3-month history of scotoma in the left eye (LE). On ophthalmologic examination, it was noted that the best-corrected visual acuity (BCVA) in the right eye (RE) was 10/10- and in the LE was 10/10-. The intraocular pressure (IOP) was 20 mmHg in the RE and 24 mmHg in the LE. Objective: To summarize, clarify and compile information on anterior ischemic optic neuropathy, with a main focus on its differential diagnosis with glaucoma, as both are causes of optic disc cupping. Methodology: Literature search related to the topic via several search engines such as PubMed, Google Scholar, Scielo, and reference journals in the field, using the following search terms: arteritic anterior ischemic optic neuropathy, glaucoma, arteritic anterior ischemic optic neuropathy differential diagnosis, CNS vasculitis, optic disc cupping. Conclusion: The main challenge of the clinical case was that the patient presented symptoms and exams consistent with the diagnosis of glaucoma, and only a complete and systemic observation of the patient contradicted this diagnosis.
Introduction: Anterior ischemic optic neuropathy (AION) and glaucomatous optic neuropathy are pathologies that can lead to irreversible vision loss. AION is an acute condition that predominantly occurs in older patients and is caused by inflammation and subsequent thrombosis of the posterior short ciliary arteries. Possible etiologies include vasculitis of the central nervous system. Glaucoma is a progressive optic neuropathy characterized by alterations in the neuroretinal rim, loss of ganglion cells and their axons, and subsequent visual field defects. A thorough study is essential for timely diagnosis and early treatment. Case report: A 58-year-old Caucasian male patient presented to the Ophthalmology Outpatient Clinic of the North Lisbon University Hospital in March 2022 with a 3-month history of scotoma in the left eye (LE). On ophthalmologic examination, it was noted that the best-corrected visual acuity (BCVA) in the right eye (RE) was 10/10- and in the LE was 10/10-. The intraocular pressure (IOP) was 20 mmHg in the RE and 24 mmHg in the LE. Objective: To summarize, clarify and compile information on anterior ischemic optic neuropathy, with a main focus on its differential diagnosis with glaucoma, as both are causes of optic disc cupping. Methodology: Literature search related to the topic via several search engines such as PubMed, Google Scholar, Scielo, and reference journals in the field, using the following search terms: arteritic anterior ischemic optic neuropathy, glaucoma, arteritic anterior ischemic optic neuropathy differential diagnosis, CNS vasculitis, optic disc cupping. Conclusion: The main challenge of the clinical case was that the patient presented symptoms and exams consistent with the diagnosis of glaucoma, and only a complete and systemic observation of the patient contradicted this diagnosis.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Neuropatia óptica isquémica anterior arterítica Glaucoma Vasculite do sistema nervoso central Escavação do disco óptico Oftalmologia