Bilateral irreversible visual loss due to arteritic anterior optic ischemic neuropathy

Abstract

Introduction: Anterior optic ischemic neuropathy (AOIN) is the most frequent cause of visual loss in giant cell arteritis (GCA). As blindness is rarely reversible, the main therapeutic goal is to prevent bilateral disease by immediate initiation of high-dose intravenous steroids. Approximately, one third of patients present with bilateral visual impairment. Case Report: A 77-year-old patient, came to the Ophthalmology Emergency Room for sudden loss of vision in the left eye (OS) to no light perception (NLP) with two days duration and significant narrowing of the visual field in the right eye (OD) with 10 hours duration. Fundus examination revealed swelling and pallor of the optic disc in both eyes (OU). Laboratory examination showed elevated ESR (56 mm/h) and CRP (5.24 mg/dl). Temporal artery biopsy (TAB) proved granulomas and fibrosis within the vessel wall. Immediate Methylprednisolon 1gm was administered intravenously for five days, followed by oral Prednisone 1mg/kg for four weeks with tapering of 10 mg per month. The patient was put on diabetic and low sodium regimen. During the 3rd day of treatment, vision OD dropped to NLP. Despite continuing systemic steroid therapy, vision remained unchanged. Two months following discharge, the patient died from myocardial infarction. Conclusion: Irreversible bilateral blindness occurred in a patient with arteritic AOIN, while he was on systemic steroids, probably due to late presentation, when vision was already affected bilaterally.