Ophthalmic giant cell arteritis in a patient with normal visual acuity

Abstract

In this study, we report a case of giant cell arteritis (GCA) and central retinal artery occlusion (CRAO) with cilioretinal artery sparing in a patient who presented with normal visual acuity and was treated with corticosteroids and tocilizumab. An 80-year-old male presented with restriction of his peripheral vision in the right eye along with fever, generalized headache, and jaw pain. His visual acuity was 20/20 in both eyes (OU) with an afferent pupillary defect in the right eye. Dilated fundoscopy revealed whitening of the retina around the vascular arcades with sparing of the central macula in the right eye, indicating CRAO sparing the cilioretinal artery. Laboratory evaluation revealed elevated inflammatory markers. The patient was treated initially with a pulse dose of intravenous corticosteroids, followed by an oral steroid taper, and he underwent a temporal artery biopsy (TAB). At 1-week follow-up, the patient reported improvement in his right eye visual symptoms. The TAB results confirmed the diagnosis of GCA, and the patient’s oral steroid was tapered with the addition of subcutaneous tocilizumab. One month later, the patient’s inflammatory markers returned to normal, and the patient’s vision remained stable. We conclude from this case that GCA may present with normal visual acuity, it can affect the central retinal artery without posterior ciliary artery involvement, and the combination of corticosteroids and subcutaneous tocilizumab may be an adequate treatment regimen.