Classic Case of Temporal Arteritis

This 88-year-old woman presented with complaints of loss of vision for several weeks, temporal pain to touch, and jaw claudication. The slit lamp exam was normal with intraocular lenses in both eyes. The fundus exam showed a chalky white, edematous optic disc with a neural rim hemorrhage at 5:00 o'clock. (green arrow) The OCT shows the hyperreflectivity of the inner retinal layers adjacent to the disc (blue arrow) and the swollen neural rim (red arrow). A c-reactive protein, Westergren sedimentation rate and platelet count were ordered, all of which were abnormally high. The patient was placed on prednisone 1mg daily and schedule for a temporal artery biopsy, which was positive for giant cells. These history and clinical findings are a classic presentation of temporal arteritis. Coverage of the patient with prednisone therapy is important to prevent fellow eye involvement with a similar event pending completion of the biopsy.