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Elderly woman with prominent temporal arteries referred for sudden painless vision loss
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An 88-year-old woman was referred urgently by rheumatology to our neuro-ophthalmology clinic due to “going blind” in her left eye starting 3 weeks before presentation in the setting of very prominent temporal arteries. She reported that her vision loss was sudden and painless and that it did not fluctuate after the initial drastic decline. She denied any prior transient vision loss, diplopia, other visual disturbances or trauma. She denied any associated headaches, fevers, chills, night sweats, jaw claudication, scalp tenderness or proximal muscle weakness. She denied any visual disturbances in her right eye.
The patient’s daughter felt that her mother’s temporal arteries appeared “particularly prominent” in the previous month. The patient’s weight reportedly fluctuated between 95 lb and 106 lb, which her daughter attributed to “being slender all her life” and a poor appetite. Due to these observations, the patient’s rheumatologist checked a C-reactive protein test, which was normal. A temporal artery biopsy was discussed at that time but deferred by the patient given her lack of associated systemic symptoms.
Her ocular history was remarkable only for refractive error, and the patient did not have an established ophthalmologist before presentation. Her medical history was significant for sarcoidosis without extrapulmonary findings, stage IV chronic renal disease, hypertension, carpal tunnel syndrome, two ankle fractures, lumbar laminectomy and atrial fibrillation controlled on amiodarone.
Click here to read the publication exclusive, Grand Rounds at the New England Eye Center, published in Ocular Surgery News U.S. Edition, February 10, 2015.