Atlas of Ophthalmology

Arteritic Anterior Ischemic Optic Neuropathy in OD and OS (Colour Photography Posterior Segment, OCT)

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Patient: 72 years of age, female, BCVA perception of light at OD, 0.6 at OS. Ocular Medical History: marked loss of vision in one eye and signs of involvement in other eye. C-reactive protein evaluation was 69 mg/l. Patient showing a high index of suspicion of giant cell arteritis was immediately started on systemic corticosteroid therapy and had temporal artery biopsy performed. Diagnosis of giant cell arteritis was confirmed on temporal artery biopsy. General medical history: headache. Purpose: to present anterior ischemic optic neuropathy in both eyes in giant cell arteritis. Methods: Colour Photography Posterior Segment, OCT. Findings: Colour Photography Posterior Segment OD: papilloedema, diffuse swelling, blurred border, no hemorrhage around the disc rim. Colour Photography Posterior Segment OS: sectoral swelling and blurred border at 6h, no hemorrhage around the disc rim. OCT OD: diffused optic disc swelling with almost total disappearance of the physiological cup, ONH fiber crowding. OCT OS: sectorial peripapillary retinal nerve fiber layer edema at 6h. Discussion: Arteritis temporalis shows a variable course of the disease and may lead to transient or permanent visual loss. Hayeh et al. (1) reported, that patients with giant cell arteritis presented a variety of ocular symptoms : visual loss of varying severity in 98%, amaurosis fugax in 31%, diplopia in 6%, and eye pain in 8%. Because giant cell arteritis is a potentially blinding disease and its early diagnosis is the key to preventing blindness, it is important to recognize its various ocular manifestations. When systemically apparent, arteritis temporalis can progress to reduction of general health, cerebral ischemia and organ infarction (2). Literature: (1) Hayreh SS, Podhajsky PA, Zimmerman B. Ocular manifestations of giant cell arteritis. Am J Ophthalmol. 1998 Apr;125(4):509-20. (2) Brüggemann A, Holl-Ulrich K, Müller M. Clinical aspects of temporal arteritis: course variations up to fatal complications. Ophthalmologe.2010 Oct;107(10):930-6

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