Anterior ischemic optic neuropathy following the use of a nasal decongestant

PURPOSE: To report a case of sequential anterior ischemic optic neuropathy temporally related to the sequential use of a decongestant nasal spray. METHODS: A 43-year-old woman was evaluated for sequential bilateral vision loss following the use of oxymetazoline nasal spray. RESULTS: Thorough investigation of possible etiologies causing the bilateral anterior ischemic optic neuropathy was negative. Our patient had several predisposing risk factors for ischemic optic neuropathy, including diabetes mellitus, hypertension, and crowded optic nerve heads. Before each acute optic neuropathy, the patient used two to three puffs of oxymetazoline nasal spray. CONCLUSION: Decongestants have been associated with ischemic and hemorrhagic vascular events. Vasoconstriction secondary to oxymetazoline use may precipitate anterior ischemic optic neuropathy.