When the Eyes Pave the Way: Takayasu Retinopathy as the First Sign of Takayasu Arteritis

Background Takayasu arteritis (TAK) is a granulomatous large-vessel vasculitis of unknown etiology that predominantly affects the aorta and its branches. Ocular involvement occurs due to ischemia from vascular stenosis or occlusion and may present as transient visual loss, Takayasu retinopathy (TR), or ischemic optic neuropathy. In rare cases, ocular symptoms can be the initial manifestation, underscoring the importance of early recognition. Case Presentation We report a 29-year-old male who presented with progressive blurring of vision, more marked in the left eye, for nine months. Systemic symptoms included presyncope and upper limb claudication. Ocular examination revealed multiple mid-peripheral microaneurysms and a wreath-like type 3 arteriovenous anastomosis near the left optic disc. Fundus fluorescein angiography showed 360° peripheral capillary nonperfusion, while Optical coherence tomography angiography demonstrated capillary dropout in the macular area in left eye. Carotid Doppler and CT angiography revealed diffuse mural thickening and near-total occlusion of major aortic arch branches. Raised C-reactive protein with negative anti-nuclear antibodies supported the diagnosis. Based on these findings, a diagnosis of TAK with stage 4 TR was made. The patient was treated with intravenous corticosteroids followed by immunosuppressants, along with panretinal photocoagulation and intravitreal ranibizumab in the left eye. Conclusion This case highlights decreased vision as the initial and predominant manifestation of TAK, accompanied by systemic vascular symptoms. The presence of advanced TR with type 3 anastomosis reflected severe, chronic ischemia. Recognizing ocular signs in conjunction with systemic features such as claudication and syncope is vital for early diagnosis. Prompt systemic immunosuppression with adjunctive ocular interventions can prevent irreversible visual loss and systemic complications.