INTRODUCTION Takayasu arteritis is an inflammatory and stenotic disease of medium and large sized arteries with a strong predilection for aortic arch and its branches. The Chapel Hill Consensus Conference on the nomenclature of systemic vasculitis defined Takayasu arteritis as “granulomatous inflammation of aorta and its major branches.” 1 The aortic branches are more commonly involved at the origin than distally. A small percentage of Takayasu patients have associated Relapsing Polychondritis (RPC). 2 Ocular ischemic syndrome is one of the ocular manifestations of Takayasu arteritis. The authors hereby describe a patient with decreased intra ocular pressure, arteriolar narrowing, venous dilation and ischemic optic neuropathy in both eyes. CASE REPORT A 35 years old Pakistani female presented in outpatient department in March 2012, with gradual loss of vision in both eyes ( more marked in the right eye) for 5 years. There was no history of ocular redness, pain, transient loss of vision, ocular trauma, haloes around light and no history of any discharge from the eyes. Family history regarding vision was unremarkable. Probing the systemic history revealed fever, malaise and weight loss. She had depressed nasal bridge for the last one year, joint pains for 2 years, breathlessness for 4 years, pain in neck, shoulders and back for 5 years. There was morning stiffness and poor healing of wounds. On enquiring the past history, it was found that she had weakness of the right half of the body at the age of 20 years, which came out to be left ischemic cerebro- vascular accident on CT scan. One year later, she developed facial nerve palsy of the left side. On ocular examination, her visual acuity was hand movements in right eye and 6/36 in left eye with no improvement with pinhole. Colour vision was defective. On applanation tonometry, intra ocular pressures were 5 mm and 4 mm of Hg in the right and left eye respectively. Pupillary reactions to light were absent in right and sluggish in the left eye. Extra ocular movements were of full range. On slit lamp examination, anterior segment was normal. Fundoscopy revealed bilateral disc pallor. There was retinal venous dilatation and arteriolar attenuation. Blood flow in the retinal arterioles was sluggish revealing cattle trucking phenomenon (Figure 1). A slight pressure on the globe revealed central retinal artery pulsations. Macular reflex was dull on both sides. Journal of the College of Physicians and Surgeons Pakistan 2015, Vol. 25 (Special Supplement 1): S47-S49 S47 CASE REPORT Ocular Ischemic Syndrome and Ischemic Optic Neuropathy in Takayasu Arteritis Tayyaba Gul Malik 1 , Muhammad Khalil 1 , Asad Ullah Ijaz 2 and Muhammad Moeen Bhatti 3 ABSTRACT Ocular Ischemic Syndrome (OIS) is a disorder, which consists of constellation of signs and symptoms secondary to chronic ocular hypoperfusion. We report a case of 35 years old Pakistani female who presented to us with gradual fall of vision in both eyes. On examination, she had bilateral OIS and ischemic optic neuropathy. The patient had past history of transient ischemic attack and facial palsy almost 20 years back. We referred her to physician for the diagnosis of Takayasu arteritis associated with relapsing polychondritis. She was given 60 mg of dexamethasone per day as initial treatment. At her last follow-up after approximately 3 months, she was quite comfortable systemically and her general condition was improved. Unfortunately, her vision did not improve. These two autoimmune diseases are rarely reported together in the same patient in Pakistan. Whether this association is rare or is underdiagnosed still remains to be answered. Key Words: Ocular ischemic syndrome. Takayasu arteritis. Relapsing polychondritis. Ischemic optic neuropathy. Carotid artery stenosis. 1 Department of Ophthalmology / Medicine 2 , Lahore Medical and Dental College, Lahore. 3 Department of Ophthalmology, Ghurki Trust and Teaching Hospital, Lahore. Correspondence: Dr. Tayyaba Gul Malik, 649-N, Samanabad, Lahore-25. E-mail: tayyabam@yahoo.com Received: March 11, 2013; Accepted: November 01, 2014. Figure 1: Left fundus photograph showing arteriolar attenuation, disc pallor and interrupted flow in the arterioles (Black arrow). Figure 2: Deformed right ear with loss of auricle at root of helix.