Lacrimal Gland Ischemia due to Giant Cell Arteritis

Heraud, Alexandre; Zmuda, Mathieu

doi:10.1016/j.ophtha.2018.04.032

Cited by 4 publications

(3 citation statements)

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“…Similarly, reported features of GCA have included ill-defined enhancement of the optic nerve pathway (parenchyma, sheath, and/or chiasm) and retrobulbar fat (1,4). High signal intensity and enhancement of the optic nerve can be associated with anterior ischemic optic neuropathy, but may also be clinically silent as demonstrated in our case (5).…”

supporting

confidence: 71%

“…With partial corticosteroid treatment, there was resolution of these radiologic findings on repeat MRI. To the best of our knowledge, lacrimal gland changes have only been described in one other case report by Heraud et al (5), whereby a patient with GCA presented with unilateral proptosis, lacrimal gland enlargement, and restricted diffusion. A scan repeated 1 month later revealed normalization of the diffusion signal, with new enhancement of the lacrimal and temporal arteries.…”

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confidence: 91%

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Giant Cell Arteritis Masquerading as Orbital Inflammatory Disease

Tong¹,

James²,

Patel³

et al. 2022

Journal of Neuro-Ophthalmology

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confidence: 71%

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confidence: 91%

Giant Cell Arteritis Masquerading as Orbital Inflammatory Disease

Tong¹,

James²,

Patel³

et al. 2022

Journal of Neuro-Ophthalmology

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“…When assessed, ophthalmic artery vessel wall enhancement was described in 10% (N=5/51) of cases. Diffusion restriction (8%, N=4/51)[20; 27-29] or T2/STIR hyperintensity (4%, N=2/51) [28; 30] of the optic nerve, diffusion restriction of the lacrimal gland (2%, N=1/51) [31], and enlargement of the extraocular muscle (2%, N=1/51) [21] were also reported. The optic nerve/chiasm showed any pathologic MR signal abnormality (e.g., postcontrast enhancement, T2-weighted/Short Tau Inversion Recovery (STIR), or diffusion restriction) in 25% (N=13/51) of cases of ocular GCA.…”

Section: Resultsmentioning

confidence: 99%

Orbital Magnetic Resonance Imaging of Ocular Giant Cell Arteritis: A Systematic Review and Individual Participant Data Meta-Analysis

Guggenberger

Pavlou

Cao

et al. 2022

Preprint

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Objectives: Spectrum and prevalence of orbital MRI findings in patients with giant cell arteritis with ischemic optic neuropathy are unknown. We conducted a systematic review and individual participant data meta-analysis of publications reporting the ophthalmologic presentation, clinical exam, and orbital MRI findings in ocular giant cell arteritis. Methods: PubMed and Cochrane databases were searched from inception to January 16, 2022. Publications reporting patient-level data on patients with ophthalmic symptoms, imaged with orbital MRI and diagnosed with biopsy-proven giant cell arteritis were included. Demographics, clinical symptoms, exam, lab, imaging, and outcomes data were extracted. Descriptive statistics were used to report prevalence rates. Methodological quality and completeness of reporting of the case reports were assessed. Results: Thirty-two studies were included comprising 51 patients (females=24; median age, 76 years). Vision loss (78%) and headache (45%) were commonly reported visual and cranial symptoms. Ophthalmologic presentation was unilateral (41%) or bilateral (59%). Fundus examination most commonly showed disc edema (64%) and pallor (49%). Average visual acuity was very poor (2.28 logMAR ± 2.18). Diagnoses included anterior (61%) and posterior (16%) ischemic optic neuropathy, central retinal artery occlusion (8%) and orbital infarction syndrome (2%). Erythrocyte sedimentation rate and c-reactive protein were elevated in 83% and 42% of cases, respectively. On MRI, enhancement of the optic nerve sheath (53%), intraconal fat (25%), and optic nerve/chiasm (14%) was most prevalent. Among patients with monocular visual symptoms, 38% showed pathologic enhancement in the asymptomatic orbit. Six of seven cases reported imaging resolution after treatment on follow-up MRIs. Incomplete reporting were limitations in this study. Conclusions: Vision loss, pallid disc edema, and optic nerve sheath enhancement are the most common clinical, fundoscopic and imaging findings reported in patients diagnosed with ocular giant cell arteritis, respectively. MRI may detect subclinical inflammation in the asymptomatic eye and may be an adjunct diagnostic tool.

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