Bilateral visual loss as a presenting manifestation Takayasu arteritis

Takayasus arteritis is a large vessel vasculitis with involvement of aorta and its major branches. Ophthalmic manifestations are not uncommon and can be found in around 45 of cases.The commonest manifestation are Takayasus retinopathy followed by other ischemic manifestationslike anterior ischemic optic neuropathy,central retinal artery occlusion and ocular ischemicsyndrome.We had a 19 year old female who was referred from Ophthalmology with acute onset of bilateral visual loss .She complained of claudication pain of both upper limbs. On examination shehad absent pulses over both upper limbs bruit over her neck had severe systemic hypertension. Her fundus examination showed bilateral secondary optic atrophy. Her CT angiogram showed diffusethickening of aortic wall ,its branches and bilateral renal arteries with gross luminal narrowing of bothcommon carotid arteries .So a diagnosis of Takayasus arteritis was made. Bilateral ischemic ocularsyndrome anterior ischemic optic neuropathy due to ocular hypoperfusion has been rarely reported and that too as a presenting manifestation is a rare entity in Takayasu's arteritis.