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Non-arteritic anterior ischaemic optic neuropathy secondary to menorrhagia in a young healthy woman
  1. Koon-Ling Koh1,
  2. Khairy Shamel Sonny Teo1,
  3. Mei-Fong Chong2,
  4. Wan-Hazabbah Wan Hitam1
  1. 1Ophthalmology Department, Universiti Sains Malaysia - Health Campus, Kubang Kerian, Malaysia
  2. 2Ophthalmology, Hospital Raja Permaisuri Bainun, Ipoh, Malaysia
  1. Correspondence to Dr Koon-Ling Koh, kl_koh{at}


Non-arteritic anterior ischaemic optic neuropathy (NAION) may develop due to severe anaemia and hypotension which is seen in acute blood loss. The devastating visual loss is often irreversible. We report a case of NAION in a 20-year-old healthy woman, who presented on the third day of a heavy menstrual cycle with hypovolaemic shock. On day 2 of admission, she had sudden right eye blurring of vision at the superior field on awakening from sleep. Funduscopy revealed a pale and swollen right optic disc. There was a dense right superior altitudinal visual field defect. Her haemoglobin level was low (3.6 g/dL), but she refused blood transfusion due to her religious belief (Jehovah’s Witness) and opted for conservative management. She later developed right optic atrophy with persistent visual field defect despite an improved haemoglobin level of 10.5 g/dL.

  • visual pathway
  • neuroopthalmology

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  • Contributors Management of patient: KLK and MFC. Write-up of the paper: KLK, MFC, KSST and W-HWH.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.