PurposeTo study the vitreopapillary interface in non‐arteritic ischemic optic neuropathy (NAION) for features that may predispose to optic nerve perfusion defects. DesignCase-control study. Participants and ControlsPatients with NAION (Study group) were compared with healthy non‐NAION patients with crowded discs (Control group I) and non-crowded optic discs (Control group II). MethodsThe vitreopapillary interface was studied in 32 eyes with NAION using high-resolution OCT scans. Results were compared with two control groups consisting of age, sex, and refraction‐matched non‐NAION individuals with crowded optic discs (Control Group I: 31 eyes) and non-crowded optic discs (Control Group II: 32 eyes). Main Outcome MeasuresThe incidence of total posterior vitreous detachment (PVD), vitreopapillary and vitreovascular attachments, and epipapillary membranes. ResultsThe rate of PVD over the macula was similar among groups (NAION: 62.5%, Control I: 61.3%, and Control II: 65.6%, p=0.93) while the posterior hyaloid remained attached to the crowded discs at a significantly higher rate (NAION: 81.2%, Control I: 83.9% and Control II: 43.7%, p=0.0005). A higher rate of focal vitreopapillary attachments on crowded discs than on non-crowded discs was noted (NAION: 72.2%, crowded control I: 58.7%, and non-crowded control II: 19.1%, p=0.007). Vitreovascular attachments (NAION: 69%, crowded control I: 3% vs non-crowded control II: 6%, p=0.00001) and dense epipapillary membranes were observed in NAION eyes. ConclusionsCrowded discs may have stronger vitreopapillary attachments. A close relationship of these attachments with optic nerve vessels may lead to the transmission of strong tractional forces by a syneretic vitreous gel, especially after macular PVD. This transduced mechanical force may contort the vessel wall and disrupt the blood flow in NAION.