Rituximab Is Not Useful in Bilateral Ocular Involvement Caused by Eosinophilic Granulomatosis with Polyangiitis

Eosinophilic granulomatosis with polyangiitis (EGPA) rarely has eye involvement and leads to blindness. We report a 59 year-old patient who was diagnosed with EGPA based on eosinophilia, bronchial asthma, mononeuritis multiplex, and positive ANCA. In addition, she had right ocular involvement with anterior ischaemic optic neuropathy (AION). The patient received intravenous (IV) methylprednisolone and followed by 500 mg of IV cyclophosphamide fortnightly. She was maintained at high dose oral prednisolone. Her vision deteriorated rapidly with sequential involvement of the left eye after the second dose of IV cyclophosphamide. Rituximab was introduced as a salvage therapy. Despite normalised eosinophil counts and a slow gradual improvement in her peripheral nerves, the visual recovery was only marginal. This is the first reported case of rituximab used in AION associated with EGPA.