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Occult giant cell arteritis: ocular manifestations
S S Hayreh1, P A Podhajsky, B Zimmerman
1Department of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, USA. sohan-hayreh@uiowa.edu
American Journal of Ophthalmology
|April 29, 1998
Summary
Occult giant cell arteritis, presenting without systemic symptoms, affects 21.2% of patients with visual loss. Early diagnosis of this form of giant cell arteritis is crucial to prevent blindness.
Area of Science:
- Ophthalmology
- Rheumatology
- Vascular Medicine
Background:
- Giant cell arteritis (GCA) is a vasculitis that can lead to vision loss.
- Occult GCA involves ocular manifestations without systemic signs.
Purpose of the Study:
- To determine the incidence and characteristics of occult GCA.
- To identify visual symptoms and ocular signs in patients with occult GCA.
Main Methods:
- Prospective study of 85 patients with biopsy-confirmed GCA and ocular involvement.
- Evaluation of systemic and ocular symptoms, signs, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels.
Main Results:
- Occult GCA was diagnosed in 21.2% of patients.
- Patients with occult GCA had lower ESR and CRP levels compared to those with systemic symptoms.
- Ocular symptoms included visual loss (100%), amaurosis fugax (33.3%), and diplopia (11.1%).
- Ocular ischemic lesions included anterior ischemic optic neuropathy (94.4%) and retinal artery occlusions.
Conclusions:
- Occult GCA is a significant cause of vision loss, occurring in over 20% of patients presenting with ocular symptoms.
- Early diagnosis of occult GCA is vital for preventing blindness.
- Suspicion for GCA should be high in individuals over 55 with visual loss, ocular ischemic lesions, and abnormal inflammatory markers, even without systemic symptoms.