Ophthalmic Manifestations of Temporal Arteritis

TEMPORAL arteritis is the name given to a local and systemic symptom complex that attacks patients between the ages of 55 and 85 years.It is a benign self-limiting disease, insidious in development, with a course lasting over several months.As the name implies, a very regular feature is an inflammation of the temporal arteries of the scalp, but the disease is not confined to these vessels and any of the cranial arteries may be involved.Many arteries elsewhere may also become inflamed, particularly the aorta and its main branches.The clinical description given by Hutchinson (1890) is similar to the acute form of the disease as it is encountered to-day; he related that he had been called to see a man, upwards of 80 years old, because he had red streaks on his head which were painful and prevented him from wearing his hat.The red streaks proved on examination to be his temporal arteries which on both sides were found to be inflamed and swollen.The streaks extended from the temporal region almost to the middle of the scalp and several branches of each artery could be distinctly traced.The condition was nearly symmetrical.During the first week when he was under my observation, pulsation could be detected in the affected vessels but it finally ceased.The tenderness then subsided and the vessels were left impervious cords.No further references to the disease appeared until Schmidt (1930) described a patient who developed a complete right-sided paracentral scotoma 8 months after his temporal arteries had been inflamed.This patient also had an aneurysm of the internal carotid artery.Horton, Magath, and Brown (1932) described two further cases of temporal arteritis, and many other papers have since been published.A general survey of the literature, together with a description of seven cases was made by Cooke, Cloake, Govan, and Colbeck (1946).They considered temporal arteritis to be a widespread arterial disease, not uncommon but rarely recognized, in which characteristic arterial and striking local signs occur, and in which inflammatory and degenerative changes in the walls of the affected arteries produce a characteristic histopathological picture.The most important clinical features are anorexia, loss of weight, joint and muscle pain, pyrexia, painful arterial thrombosis, and very severe headaches occurring in elderly patients.The pathological features are those of a subacute inflammatory process commencing in the adventitia.The vasa vasorum then become involved and