Wilkinson Ethan Charles, McLucas Michael, Ayton Tom, Dunlop Anthony
Ophthalmology, Hunter New England Local Health Network - HNELHN, New Lambton Heights, New South Wales, Australia
The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.
BMJ Case Rep. 2025 Mar 19;18(3):e262251. doi: 10.1136/bcr-2024-262251.
Giant cell arteritis (GCA) is a large vessel vasculitis with devastating visual consequences if left untreated. Classically, GCA has a predilection for the short posterior ciliary arteries which supply the optic nerve head, causing sudden painless visual loss with the development of arteritic anterior ischaemic optic neuropathy (AAION). Other ocular manifestations of GCA include central retinal artery occlusion, oculomotor nerve palsy, posterior ischaemic optic neuropathy and ocular ischaemic syndrome (OIS). OIS is a rare clinical entity, typically stemming from severe, unilateral carotid artery disease. It may present with anterior segment ischaemia heralded by hypotony and corneal oedema. Rarely, it may occur in cases of GCA. We describe an atypical presentation of OIS and oculomotor nerve palsy with contralateral AAION in an elderly patient with a delayed diagnosis of biopsy-proven GCA. This case exemplifies the importance of suspicion, early diagnosis and initiation of treatment in GCA to prevent irreversible loss of vision.
巨细胞动脉炎（GCA）是一种大血管血管炎，如果不治疗会导致严重的视力后果。典型的GCA易累及供应视神经乳头的睫状后短动脉，导致动脉炎性前部缺血性视神经病变（AAION），进而引起突然无痛性视力丧失。GCA的其他眼部表现包括视网膜中央动脉阻塞、动眼神经麻痹、后部缺血性视神经病变和眼部缺血综合征（OIS）。OIS是一种罕见的临床病症，通常源于严重的单侧颈动脉疾病。它可能表现为低眼压和角膜水肿预示的前段缺血。极少数情况下，它可能发生在GCA病例中。我们描述了一名老年患者出现OIS和动眼神经麻痹伴对侧AAION的非典型表现，该患者活检证实为GCA，但诊断延迟。这个病例例证了对GCA保持怀疑、早期诊断和开始治疗以防止不可逆视力丧失的重要性。
