Daudin J-B, Bluwol E, Chaine G, Rohart C
Service d'Ophtalmologie, Hôpital Avicenne, Université Paris XIII, Bobigny, France.
J Fr Ophtalmol. 2006 Dec;29(10):e28. doi: 10.1016/s0181-5512(06)73912-2.
Giant cell arteritis is the most common vasculitis in the elderly. Visual loss is established as the most dreaded and irreversible complication of the disease, which makes giant cell arteritis an ophthalmic emergency. It is important to recognize its various ocular manifestations; isolated cotton wool spots are one of them.
We describe a patient with constitutional symptoms and mild visual loss who was found to have giant cell arteritis. The ophthalmic examination was significant for only isolated cotton-wool spots. A delay in arm-to-retina circulation time was demonstrated by fluorescein angiography. Prompt treatment with corticosteroids led to preservation of vision and uneventful resolution of the cotton-wool spots.
Common ophthalmologic presentations include anterior ischemic optic neuropathy or choroidal ischemia when short posterior ciliary arteries are involved, and central retinal artery occlusion. Retinal ischemia has also been recognized as a possible manifestation. Because the disease concerns medium-size and larger arteries, it cannot involve terminal retinal arterioles to produce cotton-wool spots. These are probably caused by platelet microembolization from the partially thrombosed regional arteries.
Isolated cotton-wool spots can be an early ophthalmoscopic finding in giant cell arteritis and precede severe irreversible visual loss. Their detection is essential because it allows the ophthalmologist to establish a prompt treatment and preserve vision.
巨细胞动脉炎是老年人中最常见的血管炎。视力丧失是该疾病最可怕且不可逆的并发症，这使得巨细胞动脉炎成为眼科急症。认识其各种眼部表现很重要；孤立的棉絮斑就是其中之一。
我们描述了一名有全身症状和轻度视力丧失的患者，该患者被诊断为巨细胞动脉炎。眼科检查仅发现孤立的棉絮斑。荧光素血管造影显示臂至视网膜循环时间延迟。及时使用皮质类固醇治疗使视力得以保留，棉絮斑也顺利消退。
常见的眼科表现包括当睫状后短动脉受累时出现的前部缺血性视神经病变或脉络膜缺血，以及视网膜中央动脉阻塞。视网膜缺血也被认为是一种可能的表现。由于该疾病累及中大型动脉，它不会累及视网膜终末小动脉而产生棉絮斑。这些棉絮斑可能是由部分血栓形成的局部动脉的血小板微栓塞引起的。
孤立的棉絮斑可能是巨细胞动脉炎早期的眼底镜检查发现，且先于严重的不可逆视力丧失出现。检测到它们至关重要，因为这能让眼科医生及时进行治疗并保留视力。
