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

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.