Number of Patients Percent
Permanent visual loss Unilateral Bilateral
Without amaurosis fugax After amaurosis fugax
Transient visual loss Diplopia
Abbreviation: GCA, giant cell arteritis. Source: From Ref. 15.
Ischemic damage to the optic nerve or retina can cause unilateral or bilateral tonic pupils, usually with dilatation. Horner's syndrome has also been described in patients with GCA as the result of paralysis of the ocular motor or abducens nerve, ischemia of the cavernous sinus, or as a central process in the brain stem (14). Other ocular symptoms can include swelling about the eye with proptosis and periorbital swelling. Rarely, ocular hypotony may occur, as may marginal corneal ulcerations.
A retrospective study of eye disease occurring in 161 patients over a 17-year period provides a useful perspective of this complication (15). Visual manifestations occurred in about 26% of patients, and loss of vision in at least one eye occurred in about 15% (Table 4). Twenty-four patients had permanent vision loss; in 92% of these, anterior ischemic optic neuritis was the cause. Central retinal artery occlusion occurred in 8.3% of patients as the cause of permanent visual loss, and occipital infarction caused by vertebral basilar stroke occurred in one patient (4.2%). These authors noted that patients positive for HLA-DRB1 * 04 had visual manifestations more commonly than those who did not: the phenotype was found in 42% of patients versus 26% of controls (15).
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