Elisabeth De Smit1, Eoin O'Sullivan2, David A Mackey3, Alex W Hewitt4,3,5. 1. Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, The University of Melbourne, 32 Gisborne Street, East Melbourne, Victoria, 3002, Australia. elisabethd@student.unimelb.edu.au. 2. Kings College Hospital, Denmark Hill, London, UK. 3. Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia. 4. Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, The University of Melbourne, 32 Gisborne Street, East Melbourne, Victoria, 3002, Australia. 5. School of Medicine, Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia.
Abstract
BACKGROUND: Giant cell arteritis (GCA) is a systemic granulomatous vasculitis, primarily affecting medium-large arteries. It has a predilection for the aorta and its major branches, including the carotid and vertebral arteries. Ophthalmic artery involvement frequently leads to irreversible visual loss, and therefore GCA is one of the few true ophthalmic emergencies. GCA, although classified as a large vessel vasculitis, is known to affect smaller-sized vessels, resulting in a multiplicity of signs in the eye, some of which are often missed. PURPOSE: We set out to highlight some of the less frequently observed clinical signs, which may provide clues to clinically diagnosing GCA in patients presenting with non-classical features and inconclusive inflammatory markers. METHODS: We review the literature and describe the diverse ocular features and some of the systemic findings that can be associated with GCA. RESULTS: Although the most common ocular manifestation of GCA is anterior ischaemic optic neuropathy, the clinical presentation of GCA can vary dramatically. In the absence of obvious ocular involvement, more subtle ophthalmic signs of anterior segment ischaemia, such as hypotony and anisocoria, may be present at the time of initial clinical examination. CONCLUSION: There are no specific biomarkers for disease to date; therefore, pertinent history and clinical examination can guide towards diagnosis in the acute setting. The diagnostic process is not always straightforward, yet appropriate and prompt diagnosis is critical to enable timely intervention and prevent significant morbidity.
BACKGROUND: Giant cell arteritis (GCA) is a systemic granulomatous vasculitis, primarily affecting medium-large arteries. It has a predilection for the aorta and its major branches, including the carotid and vertebral arteries. Ophthalmic artery involvement frequently leads to irreversible visual loss, and therefore GCA is one of the few true ophthalmic emergencies. GCA, although classified as a large vessel vasculitis, is known to affect smaller-sized vessels, resulting in a multiplicity of signs in the eye, some of which are often missed. PURPOSE: We set out to highlight some of the less frequently observed clinical signs, which may provide clues to clinically diagnosing GCA in patients presenting with non-classical features and inconclusive inflammatory markers. METHODS: We review the literature and describe the diverse ocular features and some of the systemic findings that can be associated with GCA. RESULTS: Although the most common ocular manifestation of GCA is anterior ischaemic optic neuropathy, the clinical presentation of GCA can vary dramatically. In the absence of obvious ocular involvement, more subtle ophthalmic signs of anterior segment ischaemia, such as hypotony and anisocoria, may be present at the time of initial clinical examination. CONCLUSION: There are no specific biomarkers for disease to date; therefore, pertinent history and clinical examination can guide towards diagnosis in the acute setting. The diagnostic process is not always straightforward, yet appropriate and prompt diagnosis is critical to enable timely intervention and prevent significant morbidity.
Authors: Maria A Nagel; Teresa White; Nelly Khmeleva; April Rempel; Philip J Boyer; Jeffrey L Bennett; Andrea Haller; Kelly Lear-Kaul; Balasurbramaniyam Kandasmy; Malena Amato; Edward Wood; Vikram Durairaj; Franz Fogt; Madhura A Tamhankar; Hans E Grossniklaus; Robert J Poppiti; Brian Bockelman; Kathy Keyvani; Lea Pollak; Sonia Mendlovic; Mary Fowkes; Charles G Eberhart; Mathias Buttmann; Klaus V Toyka; Tobias Meyer-ter-Vehn; Vigdis Petursdottir; Don Gilden Journal: JAMA Neurol Date: 2015-11 Impact factor: 18.302
Authors: Elisabeth De Smit; Samuel W Lukowski; Lisa Anderson; Anne Senabouth; Kaisar Dauyey; Sharon Song; Bruce Wyse; Lawrie Wheeler; Christine Y Chen; Khoa Cao; Amy Wong Ten Yuen; Neil Shuey; Linda Clarke; Isabel Lopez Sanchez; Sandy S C Hung; Alice Pébay; David A Mackey; Matthew A Brown; Alex W Hewitt; Joseph E Powell Journal: BMC Med Genomics Date: 2018-07-23 Impact factor: 3.063
Authors: Victoria K Shanmugam; Marc Phillpotts; Timothy Brady; Monica Dalal; Shawn Haji-Momenian; Esma Akin; Kavita Nataranjan; Sean McNish; Donald S Karcher Journal: BMC Rheumatol Date: 2019-08-01