A 72-year-old woman presents with sudden profound vision loss in the right eye over 24 hours. The right optic disc is pale and swollen. Erythrocyte sedimentation rate is 95 mm/hr. Which finding would most strongly favor arteritic anterior ischemic optic neuropathy over glaucomatous optic neuropathy?

• A Disc cupping with cup-to-disc ratio asymmetry
• B Notching of the neuroretinal rim
• C Splinter hemorrhage at the disc margin
• D Disc edema with pallor and jaw claudication ✓

Explanation

Arteritic AION (giant cell arteritis) presents with pale disc edema, profound vision loss, and systemic symptoms such as jaw claudication and elevated ESR/CRP. It requires urgent high-dose steroids to prevent fellow-eye involvement. Glaucomatous neuropathy shows focal or diffuse cupping with rim notching, not pale edema. Splinter hemorrhages can occur in both conditions and are non-discriminating.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.