Purpose To assess the peripapillary perfusion in eyes with acute non-arteritic anterior ischemic optic neuropathy (NAION) using optical coherence tomography angiography (OCTA). Methods Twenty-five patients with unilateral acute NAION were included in this observational crosssectional study. They were divided into two groups: group I (25 eyes) included eyes with acute NAION, and group II (25 eyes) included fellow normal eyes. Diagnosis of NAION was based on clinical examination and fluorescein angiography. OCTA (AngioVue, Optovue) was used to evaluate the optic nerve head perfusion and measure the peripapillary vessel density in all eyes included in the study. Results Fourteen male and 11 female patients with a mean age of 60.2 ± 3.5 years were included in this study. The mean duration of presentation was 4.3 ± 0.6 days. Mean BCVA was 0.13 ± 0.06 and 0.69 ± 0.18 in eyes with NAION and normal eyes, respectively (p\0.001). The peripapillary vessel was significantly decreased in all eyes with NAION compared with normal ones (p\0.001). Two morphological changes were noted in eyes with NAION: vascular dropout related to area of disc edema in 25 eyes (100% of eyes) and vascular dilatation with tortuosity in 17 eyes (68%). Conclusion Eyes with NAION have decreased peripapillary vessel density with peripapillary vascular dilatation and tortuosity as assessed by OCTA.