Two rare causes of posterior ischaemic optic neuropathy: eosinophilic fasciitis and Wegener's granulomatosis

Case 1

An 87 year old woman, who was previously diagnosed with eosinophilic fasciitis, presented with acute visual loss of her right eye. Ten years earlier she had had a history of skin tightness and thickening affecting her arms, legs, and trunk but sparing her face. She had pain and swelling of her hands, early morning stiffness, but no Raynaud's phenomenon. Blood tests at the time showed an erythrocyte sedimentation rate (ESR) of 21 mm in the first hour, haemoglobin 12.7 g/dl, white cell count 7.6 × 10⁹/l, of which 19% were eosinophils (1–6%). Eosinophilic fasciitis was diagnosed on the basis of her clinical picture and blood eosinophilia. She was also antinuclear antibody positive; anti-double stranded DNA antibodies, anti-neutrophil cytoplasmic antibodies (ANCA), and cardiolipin antibodies were negative and protein S and C normal and she had been started on prednisolone and aspirin. She had also had several transient ischaemic attacks involving the right side of her body with paraesthesia of her face, hand, and right foot, which lasted 5 minutes at a time. She had a history …