'Eye is a window to the pulse': bilateral ocular ischaemic syndrome as a presenting manifestation of Takayasu arteritis

Abstract

A 22-year-old lady presented with gradually progressive visual loss and chronic pain in both the eyes of 3 months duration. The clinical examination and fundus fluorescein angiography were suggestive of bilateral ocular ischaemic syndrome. Her upper limb pulses were feeble and blood pressure was not recordable in the same. Carotid Doppler revealed a bilateral carotid artery occlusion. Systemic markers for inflammation were elevated. Diagnosis of Takayasu arteritis was made on the basis of clinical and laboratory findings. Takayasu arteritis should be considered in the differential diagnosis of ocular ischaemic syndrome, particularly in young Asian women.

Figure 1

A colour fundus photograph of the right eye (A) and left eye (B) showing arteriolar narrowing (horizontal arrows), venous dilation without much tortuosity (vertical arrows). Multiple microaneurysms and punctate haemorrhages (curved arrows) were present in the posterior pole extending up to the mid periphery along with few cotton wool spots in both the eyes.

Figure 2

Fundus fluorescein angiogram of the right eye showing patchy choroidal filling and delayed arm to retina circulation time (1 min and 5 s).

Figure 3

Fundus fluorescein angiogram of the left eye (A) and right eye (B) showing staining of the vessels (horizontal arrows), capillary non-perfusion areas (vertical arrows) and microaneurysms in the posterior pole (curved arrows).

Figure 4

Late phase fundus fluorescein angiogram of the left eye showing staining of the vessel walls capillary non-perfusion areas (vertical arrows) and microaneurysms in the posterior pole.

Figure 5

CT angiography of the aorta shows critical stenosis of the right brachiocephalic (BCA), the left common carotid (L CCA) and the left subclavian arteries (L SCA) with a trickle of contrast flow in the residual lumen.