CASE REPORT article
Front. Ophthalmol.
Sec. Neuro-Ophthalmology Disorders
Volume 5 - 2025 | doi: 10.3389/fopht.2025.1598302
This article is part of the Research TopicOptic Neuropathies: Etiologies, Diagnosis, and TreatmentsView all 6 articles
Bilateral Optic Perineuritis: A rare manifestation of giant cell arteritis -Case report and Literature review
Provisionally accepted
- 1King Abdulaziz Medical City, Riyadh, Saudi Arabia
- 2King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- 3King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Background: Giant cell arteritis (GCA) is a granulomatous vasculitis in older individuals that primarily affects medium-to-large vessels. Owing to the involvement of the ophthalmic arteries, GCA can lead to severe ischemic complications, including vision loss. Optic perineuritis (OPN) is characterized by inflammation around the optic nerve sheath and is a rare manifestation of GCA with diagnostic and therapeutic challenges. Case presentation: This case study reports a 75-year-old female presenting with subacute constitutional symptoms of fever and poor appetite with bilateral eye pain and visual disturbance. The patient had elevated inflammatory markers, specifically an erythrocyte sedimentation rate of 120 mm/h, with imaging findings consistent with bilateral OPN and temporal artery biopsy-proven GCA. Treatment with high-dose dexamethasone, followed by oral prednisolone and tocilizumab, led to symptomatic improvement in vision stabilization. Conclusion: This case highlights the importance of recognizing OPN as a possible manifestation of GCA. Although cases of OPN are mostly idiopathic, it can rarely represent the first manifestation of GCA. Therefore, prompt diagnosis through brain imaging and temporal artery biopsy is essential, and aggressive treatment with steroids is crucial for managing GCA-associated OPN to prevent irreversible vision loss.
Keywords: Optic perineuritis, Vision Loss, Giant Cell Arteritis, brain imaging, case report
Received: 24 Mar 2025; Accepted: 16 Jun 2025.
Copyright: © 2025 Madkhali, Aba Alkhail, Aldriweesh and Al Malik. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ahmed B. Aba Alkhail, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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