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However, due to the limited phenotypic repertoire of optic nerve injury, other conditions can closely mimic NAION, leading to diagnostic uncertainty. This review outlines the key clinical, imaging and systemic features that help differentiate NAION from its major masquerades, including arteritic anterior ischaemic optic neuropathy, demyelinating optic neuritis, autoimmune and granulomatous diseases, hereditary optic neuropathies, incipes and vascular abnormalities. Particular attention is given to the diagnostic pitfalls and red flags that should prompt reconsideration of the diagnosis. A hypothesis\u2010driven approach based on history, examination and targeted investigations is essential to avoid misdiagnosis and inappropriate management. Recognising atypical features early can significantly alter prognosis and guide timely and appropriate therapy.<\/jats:p>","DOI":"10.1111\/ceo.70061","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T01:00:21Z","timestamp":1773709221000},"page":"537-553","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Non\u2010Arteritic Anterior Ischaemic Optic Neuropathy and Its Masquerades: A Comprehensive Diagnostic Review"],"prefix":"10.1111","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6206-2221","authenticated-orcid":false,"given":"Alexandra L.","family":"Lawrence","sequence":"first","affiliation":[{"name":"Department of Ophthalmology Te Whatu Ora Te Tai Tokerau  Whang\u0101rei New Zealand"},{"name":"University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Savino","sequence":"additional","affiliation":[{"name":"Shiley Eye Institute, UC San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen V.","family":"Danesh\u2010Meyer","sequence":"additional","affiliation":[{"name":"Academic Glaucoma and Neuro\u2010Ophthalmology, Vision Research Foundation  Auckland New\u00a0Zealand"},{"name":"Department of Ophthalmology University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2008.01.012"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(87)33263-4"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9394(88)90591-0"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.2008.143297"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1985.01050080055019"},{"issue":"3","key":"e_1_2_8_7_1","first-page":"171","article-title":"Ischaemic Optic Neuropathy","volume":"48","author":"Hayreh S. 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