Non-arteritic anterior ischemic optic neuropathy (NAION) is the most common acute optic neuropathy in patients over 50 years of age, yet no effective treatment supported by high-quality evidence is currently available. Inappropriate use of glucocorticoids is common in clinical practice, including using them as a diagnostic therapeutic trial, as routine treatment, and underestimating their systemic risks. From the perspective of the pathological mechanism, NAION is primarily caused by hypoperfusion-induced ischemia, with secondary inflammation occurring after the ischemic insult. This indicates that anti-inflammatory treatment is not the first choice for addressing the fundamental problem. The highest level of evidence indicates that systemic glucocorticoid therapy only accelerates the resolution of optic disc edema but does not improve long-term visual acuity or visual field outcomes. Moreover, it may exacerbate vascular risk factors such as hyperglycemia and hypertension, and may lead to adverse reactions, including peptic ulcers, osteoporosis, and infections. Neither intravitreal nor periocular steroid injection is supported by high-quality evidence. The diagnosis and management of NAION should focus on accurate diagnosis and control of risk factors. Routine use of glucocorticoids is not recommended; they may only be used with caution on an individualized basis in a few strictly selected cases, with close monitoring of adverse effects.
