Lessons to be learned: a case study approach--a case of temporal arteritis

Area of Science:

• Ophthalmology
• Neurology
• Rheumatology

Background:

• Anterior ischemic optic neuropathy (AION) is a common cause of sudden, painless vision loss in older adults.
• Giant cell arteritis (GCA) is an important treatable cause of AION, necessitating prompt diagnosis and management.
• Early detection and treatment of AION, particularly when associated with elevated inflammatory markers, are crucial for visual prognosis.

Observation:

• A 71-year-old male presented with acute, partial visual loss and an inferior visual field defect in the right eye.
• Clinical examination revealed reduced visual acuity, a relative afferent pupillary defect, and a pale, swollen optic disc, consistent with AION.
• An elevated erythrocyte sedimentation rate (ESR) of 75 mm/hr was noted 16 days after initial presentation.

Findings:

• The provisional diagnosis of AION was made promptly.
• Despite the elevated ESR, systemic steroid treatment was initiated late.
• The patient progressed to total blindness in the affected right eye due to delayed intervention.

Implications:

• This case highlights the critical importance of timely intervention in suspected AION, especially with elevated ESR.
• Failure to act promptly on inflammatory markers can lead to irreversible vision loss.
• Emphasizes the need for urgent management protocols for AION to prevent permanent visual impairment.