Posterior ischemic optic neuropathy (PION) may occur during the perioperative period and can result in unilateral or bilateral visual loss following surgery. Posterior ischemic optic neuropathy occurs when there is infarction of the optic nerve posterior to the lamina cribosa. A patient with one or more risk factors may benefit from closer monitoring and early intervention during and after surgery.

Risk factors:

(1) middle aged  (mean age 45-50 years)

(2) male gender

(3) spine surgery

(4) prolonged perioperative hypotension

(5) perioperative blood loss (usually >= 2 liters) with drop in hemoglobin and hematocrit (typically >= 10%)

(6) facial edema

(7) atherosclerotic vascular disease



(1) close monitoring of middle aged men undergoing  surgery, especially if there is atherosclerotic vascular disease, significant bleeding or spinal surgery

(2) aggressively treating hypotension, anemia and facial edema

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