Anterior segment ischaemia with giant cell arteritis

Area of Science:

• Ophthalmology
• Rheumatology
• Vascular Medicine

Background:

• Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting large and medium-sized arteries.
• It is a well-established cause of anterior ischemic optic neuropathy (AION).
• Anterior segment ischemia (ASI) is less commonly associated with GCA and typically involves smaller anterior ciliary arteries.

Observation:

• A 69-year-old male presented with blurred vision, periocular pain, and headache.
• Ocular examination revealed ipsilateral optic neuropathy and anterior segment ischemia.
• Elevated inflammatory markers (ESR, CRP) and positive temporal artery biopsy confirmed GCA.

Findings:

• The patient's presentation included both AION and ASI.
• This case demonstrates a rare manifestation of GCA involving the anterior segment.
• The condition occurred without posterior segment involvement in the affected eye.

Implications:

• This case expands the known spectrum of ocular manifestations of GCA.
• It suggests that GCA, though typically affecting larger vessels, can rarely impact smaller vessels causing ASI.
• Early recognition and treatment of GCA are crucial to prevent vision loss from its diverse ocular complications.