A Case Report of Bilateral Sequential Central Retinal Artery Occlusion in Occult Giant Cell Arteritis: The Eyes Are Windows to Systemic Disease

TL;DR

A 59-year-old man experienced sudden vision loss in both eyes due to a rare form of giant cell arteritis, highlighting the importance of early diagnosis to prevent complications.

Contribution

This case report highlights the rare presentation of occult giant cell arteritis through bilateral sequential retinal artery occlusion.

Findings

The patient presented with sudden vision loss in both eyes, indicating bilateral central retinal artery occlusion.

Diagnosis was confirmed through elevated inflammatory markers and a classic halo sign on temporal artery ultrasound.

Delayed systemic evaluation led to sequential ocular involvement, emphasizing the need for prompt diagnosis.

Abstract

Giant cell arteritis (GCA) is an inflammatory condition generally affecting medium to large arteries, commonly affecting the carotid artery and its branches. GCA generally presents with systemic symptoms such as temporal headache, jaw claudication, and polymyalgia rheumatica. Occult GCA is a variant where patients present with ocular complaints without any systemic manifestations. We report a case of a 59-year-old male who presented with a sudden, profound, and painless loss of vision in his right eye. Fifteen days later, he presented with a similar loss of vision in his left eye, which had occurred five days before presentation. Ophthalmological examination revealed posterior segment involvement suggestive of central retinal artery occlusion in the right eye. He was lost to follow-up between both presentations, which delayed the systemic evaluation and led to a sequential attack in the left eye. The disease was diagnosed based on raised inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) with a classic halo sign on temporal artery ultrasound. The systemic treatment is multidisciplinary and must be initiated early to prevent ocular complications.

Figures