Thick corneas, large pupils, and a giant problem

An 87-year-old woman presented 1 month after uneventful cataract surgery with ipsilateral corneal edema. She was diagnosed with pseudophakic bullous keratopathy and scheduled for endothelial transplantation. A few days later, however, she presented with bilateral corneal edema, dilated pupils, and further reduction of visual acuity. Neuro-ophthalmic evaluation disclosed a bilateral ocular ischemic syndrome causing complete visual loss. Temporal artery biopsy was consistent with giant cell arteritis. Corneal decompensation should be considered as a rare presentation of giant cell arteritis, a diagnosis that ophthalmologists should suspect in any case of unilateral or bilateral ocular ischemic syndrome.