Zöller C.-C., Schmidt W.

Zentrum für Augenheilkunde, Friedrichstraße 18, D-35392 Gießen

Background: The rare case of an bilateral sectorial optic neuropathy after suicide attempt with anemia will be presented.
Patient: A 23-year-old man was seen 10 days after suicide attempt with bilateral inferior visual-field defects in our clinic. Owing to the suicide attempt with incision of Aa. radiales the laboratory value of haemoglobin was 53 g/l.
Results: In primary examination the best corrected visual acuity of the right eye was 1.0 and of the left eye was 1.2. The visual-field examination (Goldmann) showed a rather defect of the inferior quadrants and a central scotoma for the mark I3 of the right eye and a defect of the infereronasal quadrant of the left eye. The indirect ophthalmoscopy showed bilateral prominent diffuse optic nerve discs. The sonographic examination of the orbital cavity, the MRI and the neurological investigation showed no morphological pathology. The coreometry showed 7 mm to the right and 5 mm to the left eye. The swinging-flashlight-test was negative. During nine months could be demonstrated by indirect ophthalmoscopy and fluorescein angiography a superior optic atrophy to the right and a superotemporal optic atrophy to the left eye correlating to the visual-field defects. The central scotoma to the right eye could not be detected once more. The other controls showed no alteration in the visual-field. The last visual acuity of either eye was 1.2
Conclusion: A bilateral ischemic anterior optic neuropathy is a rare complication of massive anemia after acute blood loss and may cause permanent visual-field defects without loss of foveal vision. Therefore it is important to recognize alongside foveal vision the details of visual-field to initiate early a sufficient therapy.

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