Pulseless and blindness – An ophthalmologist’s role in diagnosing Takayasu arteritis: Case series and brief review of literature

Abstract

Purpose: To study the initial presenting symptoms of Takayasu arteritis in unsuspecting patients. Methods: The underlying systemic condition was suspected in five subjects at a tertiary eye care center based on their ocular features. Similar reports in the literature were collated and analyzed for the common presenting features of undiagnosed Takayasu arteritis. Results: The most common presenting ophthalmic symptoms were vision loss (86.8%), ocular pain (21.1%), eye redness (18.4%), and photophobia (5.3%). There were no reports of glaucoma at presentation. Pupillary abnormalities (42.1%), microaneurysms in retinal mid-periphery (42.1%) and venous engorgement (28.9%) were the most common presenting signs. Despite systemic symptoms such as headache, dizziness, fatigue, weakness, arm claudication, fever, anorexia, weight loss, and syncope in 76.3% of cases, the patients in this series had never sought medical care before developing ocular symptoms. Conclusion: Takayasu arteritis may remain latent until the ophthalmic complications compel the patient to seek medical attention. Hence, ophthalmologists need to be aware of the seemingly innocuous presentations of the disease.

Posterior segment manifestations of Takayasu arteritis: A narrative review

“…Constriction in the field of view might be the presenting symptom of a patient with TA. [ 74 ] The visual field deficits could be due to ischemic optic neuropathy,[ 53 64 ] vascular occlusion, ocular ischemia, or cerebrovascular accident. [ 6 ] Visual field damage can be variable, including mild-to-severe constriction of fields, mild reduction in sensitivity to global depression, mild paracentral depression, cecocentral scotoma, enlarged blind spot, inferonasal step, superonasal field depression, superior arcuate defect, altitudinal defect, and homonymous hemianopia.…”

“…[ 6 ] Visual field damage can be variable, including mild-to-severe constriction of fields, mild reduction in sensitivity to global depression, mild paracentral depression, cecocentral scotoma, enlarged blind spot, inferonasal step, superonasal field depression, superior arcuate defect, altitudinal defect, and homonymous hemianopia. [ 28 46 59 68 71 74 75 76 ]…”

“…Supplementary material 4 gives details of the studies included for analysis of various parameters. [ 2 3 5 6 7 8 11 12 13 14 15 17 18 19 20 26 29 30 31 32 33 34 35 36 38 39 40 41 42 44 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 65 66 68 69 70 71 72 74 75 76 77 78 83 84 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 ]…”