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Neurological Rehabilitation

Waking From Surgery with Blindness; A Case of Posterior Ischemic Optic Neuropathy and Ramifications of New-Onset Blindness

Friday, October 24, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 6

    Poster Presenter(s)

  • Hannah Park, DO

    Resident
    New York University Grossman School of Medicine PM&R Program
    New York, New York

    • Co-Author(s)

  • DG

    Daniel Good, DO

    PM&R Resident
    New York University Grossman School of Medicine PM&R Program
    New York, New York

  • Andres Gronda, MD

    Resident
    New York University Grossman School of Medicine PM&R Program
    New York, New York

  • CC

    Cherie Chen, DO (she/her/hers)

    Resident Physician
    New York University Grossman School of Medicine PM&R Program
    New York, New York

  • AB

    Amit K. Bansal, DO

    Clinical Instructor
    NYU Med CntrNYU Hospital for Joint Disease
    New York, New York

Disclosure(s):
Hannah Park, DO: No financial relationships to disclose
Andres Gronda, MD: No financial relationships to disclose
Case Diagnosis: 63-year-old female was admitted for planned lumbar fusion surgery and woke with complete bilateral blindness due to posterior ischemic optic neuropathy

Case Description or Program Description: 63-year-old female underwent revision lumbar fusion due to progressive low back and radicular pain. She remained intubated post-operatively due to facial edema and shallow breathing but upon extubation, patient reported complete blindness bilaterally. Ophthalmology was consulted and determined posterior ischemic optic neuropathy was the most likely diagnosis given her anemia, hypotension, prolonged prone positioning, and possible venous congestion suggested by facial edema.

Setting: Acute inpatient rehabilitation

Assessment/Results: Patient was admitted to inpatient rehabilitation and noted to have minimal pupillary reflex, incomplete abduction of the eyes, and no visual input. She was occasionally noted to have visual hallucinations, saying that she saw people who were not present. Her visual deficits caused difficulties with education, sleep/wake cycles, and coping during her rehabilitation course.

Discussion (relevance): Ischemic optic neuropathy can occur as a result of giant cell arteritis, other medical causes, or as a complication of prolonged surgeries. Controversy exists regarding pathogenesis and management of this disease. Systemic steroids can be beneficial in certain types of ischemic optic neuropathy but have minimal benefit in surgical cases. New onset blindness can cause impaired mobility, increased risk of falls, and difficulty with completing ADLs. It can also cause feelings of social isolation, depression, and anxiety while adapting to the new visual deficits. Cognitive decline with difficulties with memory, spatial orientation, and overall cognitive function has also been associated with new-onset blindness as well as hallucinations, which are seen in 50-60% of patients.

Conclusions: PION after surgery is a rare cause of acquired blindness but can cause severe, bilateral, often irreversible vision loss. Understanding the ramifications of new-onset blindness is important as it can lead to significant debilitating effects on function, cognition, mood, and quality of life.