Ocular Complications of Giant Cell Arteritis: An Acute Therapeutic Emergency

Abstract

The risk of blindness, due to acute ischemic ocular events, is the most feared complication of giant cell arteritis (GCA) since the middle of the 20th century. A decrease of its rate has occurred after the advent of corticoid therapy for this vasculitis, but it seems to have stabilized since then. Early diagnosis and treatment of GCA is key to reducing its ocular morbidity. However, it is not uncommon for ophthalmological manifestations to inaugurate the disease, and the biological inflammatory reaction may be mild, making its diagnosis more challenging. In recent years, vascular imaging has opened up new possibilities for the rapid diagnosis of GCA, and ultrasound has taken a central place in fast-track diagnostic processes. Corticosteroid therapy remains the cornerstone of treatment and must begin immediately in patients with visual symptoms and suspicion of GCA. In that situation, the administration route of corticotherapy, intravenous or oral, is less important than its speed of delivery, any hour of delay worsening the prognosis.

Keywords: diagnosis; giant cell arteritis; ophthalmologic manifestations; treatment.

Figure 1

(A) Chalky white optic disc edema (black arrow) of the right eye (RE); (B) indocyanin green angiography showing severe choroidal hypoperfusion of a large nasal part of the right eye (white arrows); (C,D) fluorescein angiography showing non perfusion of two-thirds of the optic disc (white arrows), outside an upper crescent, and cilio-retinal artery occlusion (yellow arrow) in the right eye (C) and blurring of the lower optic disk margin (white arrows) and hypoperfusion of a long cilioretinal artery (yellow arrows) in the left eye (LE) (D).

Figure 2

(A,B) Goldman perimetry showing constriction of the superonasal left visual field (upper arrows) and to a lesser extent of its inferonasal part (lower arrows), 2 days after treatment start (A), and its improvement 10 days after its start (B). The Roman and Arabic numerals in the images correspond to an increase in size, from 0 to V, and a decrease in intensity, from 4 to 1, of the light signal sent to the patient during the examination to determine the limits of his visual field. Thus, V4 corresponds to the largest and most intense light spot possible.