Giant cell arteritis: the internist should not be a lone rider in this potentially blinding condition

Area of Science:

• Ophthalmology
• Rheumatology
• Internal Medicine

Background:

• Giant cell arteritis (GCA) is a systemic vasculitis often affecting older adults.
• Anterior ischemic optic neuropathy (AION) is a leading cause of sudden, painless vision loss in the elderly.
• GCA is a critical, treatable cause of AION that requires prompt management.

Observation:

• A 66-year-old woman presented with visual loss secondary to AION.
• Clinical and hematological findings supported the diagnosis of GCA.
• Despite initial corticosteroid therapy, the contralateral eye became involved, leading to permanent bilateral vision loss.

Findings:

• The patient experienced two relapses of GCA within six months of the initial episode.
• Corticosteroid treatment, while initiated, did not prevent disease progression or contralateral eye involvement.
• The case highlights the potential for GCA to cause severe, bilateral vision loss despite treatment.

Implications:

• Ophthalmologists must be highly familiar with the clinical presentation and diagnostic criteria for GCA.
• Active participation of ophthalmologists in the management, including corticosteroid tapering, is essential.
• Multidisciplinary collaboration is vital to prevent irreversible blindness in patients with GCA.