Giant cell arteritis presenting with cotton wool spots

Introduction: Giant cell arteritis is a granulomatous arteritis that often presents to ophthalmology. Methods: Case report. Results: A 69-year-old female presented with moderate vision loss OD after suffering from severe, generalized head and neck pain over the previous 3 months. Fundus examination revealed multifocal cotton wool patches in the posterior pole surrounding the optic disc. A fluorescein angiogram OD demonstrated a large peripapillary choroidal filling defect. Erythrocyte sedimentation rate was 86 mm/hr and her C-reactive protein was 9.2 mg/dL. She was immediately started on intravenous corticosteroid therapy, and she noted rapid improvement of her symptoms. A temporal artery biopsy was positive for giant cell arteritis. Conclusion: Ophthalmologists should be aware that cotton wool patches may be the presenting sign of giant cell arteritis. Fluorescein angiography may be helpful in these cases to demonstrate concomitant choroidal ischemia.