Cotton-wool spots and the early diagnosis of giant cell arteritis.

Neal Barney // Publications // Nov 01 1995

PubMed ID: 9098251

Author(s): Melberg NS, Grand MG, Dieckert JP, Barney NP, Blumenkranz MS, Boone DE, Folk JC, Stransky TJ. Cotton-wool spots and the early diagnosis of giant cell arteritis. Ophthalmology. 1995 Nov;102(11):1611-4.

Journal: Ophthalmology, Volume 102, Issue 11, Nov 1995

BACKGROUND Giant cell arteritis is a common cause of severe visual loss in older individuals. Patients often present to the ophthalmologist having already lost vision in one eye. Detection of early ophthalmoscopic signs that precede irreversible visual loss in giant cell arteritis would allow preventative treatment in an otherwise frequently blinding disease.

METHODS Case presentations.

RESULTS Seven patients with mild visual symptoms and results of an ophthalmologic examination significant for cotton-wool spots were found to have giant cell arteritis. On specific questioning, six of seven patients described constitutional symptoms consistent with giant cell arteritis. Six patients had an abnormally elevated Westergren erythrocyte sedimentation rate. Temporal artery biopsy confirmed giant cell arteritis in six patients. The seventh patient received a diagnosis of polymyalgia rheumatica. Prompt treatment with corticosteroids led to preservation of vision and uneventful resolution of the cotton-wool spots in all seven patients.

CONCLUSION Cotton-wool spots are an early ophthalmoscopic finding in giant cell arteritis and can precede severe visual loss. Recognition of the significance of cotton-wool spots, use of laboratory studies, and prompt treatment may preserve vision in an otherwise frequently blinding disease.