Which medication has been reported in association with nonarteritic anterior ischemic optic neuropathy?

• A. Latanoprost
• B. Sumatriptan (Imitrex)
• C. Prednisolone
• D. Timolol

Answer: (B)

Vasoconstrictive medications used for migraine can precipitate ischemia in the optic nerve head, leading to nonarteritic anterior ischemic optic neuropathy. Sumatriptan, a triptan that activates 5-HT1B/1D receptors, causes powerful vasoconstriction of cerebral and ocular vessels. In individuals with risk factors or a small cup-to-disc ratio, this reduced blood flow can compromise the optic nerve head perfusion enough to trigger NAION, and there are case reports linking sumatriptan use to this condition.

The other drugs listed aren’t recognized to have a causal link with NAION. Latanoprost lowers intraocular pressure by increasing aqueous outflow and isn’t associated with optic nerve ischemia. Prednisolone doesn’t have a known association with NAION, and timolol, a topical beta-blocker, isn’t linked to NAION either.