Vasculitis and ischaemic optic neuropathy associated with rheumatoid arthritis

Fundus lesions are said not to be found in direct relationship to rheumatoid arthritis. A vasculitis or retinopathy if present is said to be secondary to concomitant hypertension or due to some connective tissue disease other than rheumatoid arthritis. The case is presented of a 64-year-old female with sero-positive rheumatoid arthritis. During a period of exacerbation of her arthritis she developed anterior ischaemic optic neuropathy (A.I.O.N.) resulting in blindness of one eye, followed two weeks later by a temporary occlusive episode in a cilioretinal arteriole in the other eye. The patient was normotensive and had neither clinical nor immunological evidence of other connective tissue disease. The patient died two months later from cardiac arrhythmia. The autopsy findings confirming posterior ciliary arteritis as the cause of the A.I.O.N. are presented. The subject of rheumatoid vasculitis in relation to the eye is reviewed and immunological mechanisms and investigations discussed.