COTTON-WOOL SPOTS AND THE EARLY DIAGNOSIS OF GIANT-CELL ARTERITIS

Background: Giant cell arteritis is a common cause of severe visual lo ss in older individuals. Patients often present to the ophthalmologist having already lost vision in one eye. Detection of early ophthalmosc opic signs that precede irreversible visual loss in giant cell arterit is would allow preventative treatment in an otherwise frequently blind ing disease. Methods: Case presentations. Results: Seven patients with mild visual symptoms and results of an ophthalmologic examination sig nificant for cotton-wool spots were found to have giant cell arteritis . On specific questioning, six of seven patients described constitutio nal symptoms consistent with giant cell arteritis. Six patients had an abnormally elevated Westergren erythrocyte sedimentation rate. Tempor al artery biopsy confirmed giant cell arteritis in six patients. The s eventh patient received a diagnosis of polymyalgia rheumatica. Prompt treatment with corticosteroids led to preservation of vision and uneve ntful resolution of the cotton-wool spots in all seven patients. Concl usion: 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 pro mpt treatment may preserve vision in an otherwise frequently blinding disease.