CaseReport Combined Left Central Retinal Artery Occlusion and Bilateral Anterior Ischemic Optic Neuritis: A Rare Presentation of Giant Cell Arteritis Anne D. D. Joseph , 1 Jebananthy Anandaselvam Pradeepan , 1 Thirunavukarasu Kumanan , 1 and Muthusamy Malaravan 2 1 University Medical Unit, Teaching Hospital Jaffna, Jaffna, Sri Lanka 2 Department of Ophthalmology, Teaching Hospital Jaffna, Jaffna, Sri Lanka Correspondence should be addressed to Anne D. D. Joseph; anne.rajendrenjoseph@yahoo.com Received 30 April 2019; Revised 11 August 2019; Accepted 4 September 2019; Published 22 September 2019 Academic Editor: Constantine Saadeh Copyright © 2019 Anne D. D. Joseph et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Giant cell arteritis, a large vessel vasculitis is characterized by headache, visual impairment, constitutional symptoms, and increased inflammatory markers. Visual involvement in giant cell arteritis ranges from amaurosis fugax to permanent visual loss, and extensive bilateral visual impairment is a rare presentation. We hereby report a case of combined left central retinal artery occlusion and bilateral anterior ischemic optic neuritis in a patient who poorly responded to standard corticosteroid therapy. 1. Introduction Giant cell arteritis (GCA), also known as temporal arteritis, is the most common systemic vasculitides in older adult populations [1, 2]. It is a disease often observed in the age group of more than 50years with the peak incidence in the seventh decade. Many of the symptoms and signs of the GCA are due to the involvement of the cranial branches of arteries that originate from the arch of the aorta, but the vascular involvement can be widespread. e most common symptom of GCA is a new onset headache, usually around the temporal region. Abrupt onset of visual disturbances, in particular transient monocular visual loss, jaw claudication, unexplained fever, fatigue, anemia, or other constitutional symptoms and signs with high erythrocyte sedimentation rate (ESR) and/or high serum C-reactive protein (CRP) are the common observations at presentation. Simul- taneous onset of bilateral visual loss is an unusual clinical entity. 2. Case Presentation A 75-year-old lady, known patient with optimally con- trolled hypertension with amlodipine monotherapy for 5 years duration, presented with sudden painless onset of visual blurring involving the left eye for 3 days duration which was progressed to the level of perception of light (Pl) on the same side. Approximately 24 hours later, she developed gradual blurring of vision in the right eye too. Shehadleft-sidedintermittentjawpainforaweekpriorto the onset of visual symptoms; however, she did not have a history of fever, frontotemporal headache, malaise, or constitutional symptoms. Past ophthalmological history included bilateral uncomplicated cataract extraction two years prior to the current presentation, and her visual acuity was 6/12 in the left eye and 6/12 in the right eye prior to the admission. On examination, she was oriented and alert with the Glasgow Coma Scale (GCS) of 15 out of 15, was afebrile, and had tenderness over the left temporal region, but no thickening of the temporal artery was noted. Ophthalmic examination showed her visual acuity in the left eye Pl; in right eye, it was 1/ 10 with complete ocular motility. Other system examinations including the neurological examination were unremarkable. Detailed examination of the eyes by the ophthalmology team revealed both pseudophakic eyes with normal intraocular Hindawi Case Reports in Rheumatology Volume 2019, Article ID 3236821, 3 pages https://doi.org/10.1155/2019/3236821