[Rare ocular manifestation of Horton's disease].

BACKGROUND

Ocular manifestations of giant cell arteritis are anterior ischaemic optic neuropathy (AION) or retinal vessel occlusion. Rarely, it can also cause choroidal infarction or tonic pupil.

METHODS

Five patients with the diagnosis of giant cell arteritis and rare ocular manifestations are described. The analysis comprises: age, sex, best corrected visual acuity, anterior eye segment, fundus findings, fluorescein angiography (FAG), C-reactive protein, erythrocyte sedimentation rate and biopsy of the temporal artery.

RESULTS

The age ranged from 71 to 82 years (median: 76.5), sex distribution f : m = 4 : 1. The visual acuity was between light perception and 1 / 7.5 (median: 1 / 15 LT) on first examination and between light perception and 0.4 (median: 0.3) after therapy. 4 / 5 patients revealed chorioidal ischaemia combined with an AION, an atypical central-arterial-occlusion or a branch retinal artery occlusion on FAG. 1 / 5 showed an anterior ischaemia with corneal oedema, anterior chamber inflammation and pupillotonia, but without involvement of the fundus. The patients had typical symptoms for Horton's disease, such as headache, jaw claudication and weight loss. At first examination, the C-reactive protein was 17.8 - 144 mg/L (median: 76) and the ESR was 28 - 92 mm/h (median: 83.5). After mega dose therapy with decortin H (500 mg/day) i. v. for 3 days and then slowly tapering from 1 mg/kg BW orally the CRP decreased to 1.8 - 50 mg/L (median: 113) and the ESR to 1 - 30 mm/h (median: 15). The diagnosis of giant cell arteritis was proven in 3 / 5 cases with a biopsy of the temporal artery, two patients refused the biopsy.

CONCLUSIONS

There are different ocular manifestations of giant cell arteritis. In rare cases it can cause an ischaemia of the anterior eye segment or chorioidal infarctions. Especially in combined occlusions of the retinal and choroidal vessels with AION or tonic pupil Horton's disease must be ruled out because of the high risk of blindness in one or even both eyes. Therefore early diagnosis and treatment of giant cell arteritis is important.