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An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
Published on: February 8, 2019
Giant cell arteritis: ophthalmic manifestations of a systemic disease
Elisabeth De Smit1, Eoin O'Sullivan2, David A Mackey3
1Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, The University of Melbourne, 32 Gisborne Street, East Melbourne, Victoria, 3002, Australia. elisabethd@student.unimelb.edu.au.
Insights
Giant cell arteritis (GCA) can present with subtle ocular signs beyond typical ischemic optic neuropathy. Recognizing these less common features is crucial for timely diagnosis and preventing vision loss.
Area of Science:
- Ophthalmology
- Rheumatology
- Systemic Vasculitis
Background:
- Giant cell arteritis (GCA) is a systemic granulomatous vasculitis affecting medium-to-large arteries, including those supplying the eye.
- Ophthalmic artery involvement in GCA can lead to irreversible vision loss, classifying it as an ophthalmic emergency.
- GCA, though a large vessel vasculitis, can affect smaller vessels, causing diverse and sometimes overlooked ocular signs.
Purpose of the Study:
- To identify less common clinical signs of GCA that aid diagnosis in patients with atypical presentations.
- To provide diagnostic clues for GCA when inflammatory markers are inconclusive.
Main Methods:
- Literature review of GCA ocular manifestations.
- Description of diverse ocular and associated systemic findings of GCA.
Main Results:
- Anterior ischemic optic neuropathy is the most common ocular sign of GCA.
- Subtle signs of anterior segment ischemia, like hypotony and anisocoria, may be present even without overt ocular involvement.
Conclusions:
- Diagnosis of GCA relies on clinical examination and patient history in the absence of specific biomarkers.
- Prompt diagnosis is critical for intervention and preventing severe morbidity associated with GCA.
Background:
Giant cell arteritis (GCA) is a systemic granulomatous vasculitis, primarily affecting medium-large arteries. It has a predilection for the aorta and its major branches, including the carotid and vertebral arteries. Ophthalmic artery involvement frequently leads to irreversible visual loss, and therefore GCA is one of the few true ophthalmic emergencies. GCA, although classified as a large vessel vasculitis, is known to affect smaller-sized vessels, resulting in a multiplicity of signs in the eye, some of which are often missed.
Purpose:
We set out to highlight some of the less frequently observed clinical signs, which may provide clues to clinically diagnosing GCA in patients presenting with non-classical features and inconclusive inflammatory markers.
Methods:
We review the literature and describe the diverse ocular features and some of the systemic findings that can be associated with GCA.
Results:
Although the most common ocular manifestation of GCA is anterior ischaemic optic neuropathy, the clinical presentation of GCA can vary dramatically. In the absence of obvious ocular involvement, more subtle ophthalmic signs of anterior segment ischaemia, such as hypotony and anisocoria, may be present at the time of initial clinical examination.
Conclusion:
There are no specific biomarkers for disease to date; therefore, pertinent history and clinical examination can guide towards diagnosis in the acute setting. The diagnostic process is not always straightforward, yet appropriate and prompt diagnosis is critical to enable timely intervention and prevent significant morbidity.
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