Objective: To analyze the differentiating manifestations of glaucomatous and non-glaucomatous optic neuropathies using real clinical cases and to enhance the ability to make differential diagnosis. Methods: By using case study and literature review methods, we recorded three neuro-ophthalmic cases that were prone to being misdiagnosed as normal tension glaucoma (NTG). The diagnosis was established by extracting features related to visual acuity, intraocular pressure, pupillary light reflex, optic disc morphology, retinal nerve fiber layer (RNFL) thickness and visual field damage. Results: Case 1 presented with arcuate visual field defects, shallow optic disc cupping, and contralateral crowded discs. During follow-up, the patient subsequently developed acute anterior ischemic optic neuropathy (AION), and the final diagnosis confirmed was confirmed as optic atrophy secondary to AION. Case 2 exhibited a disproportionate visual acuity decline and visual field defects that were inconsistent with glaucomatous structural damage. MRI confirmed the diagnosis of left optic nerve sheath meningioma. Case 3 involved a young male who presented with central vision loss and shallow optic disc cupping. Genetic testing confirmed Leber's hereditary optic neuropathy (LHON). Conclusions: Through these representative neuro-ophthalmology cases, we illustrate the characteristic patterns of structural and functional damage associated with AION, optic nerve sheath meningioma, and LHON, such as shallow optic disc cupping, central vision loss, and inconsistency between optic nerve structural damage and visual function. These findings highlight the key differentiating features of these conditions from NTG.
