Giant Cell Arteritis

Giant cell artertis (GCA), also known as temporal arteritis, is an autoimmune disorder that causes inflammation of the medium and large arteries of the body.  Loss of vision due to temporal arteritis is commonly managed by a neuro-ophthalmologist.

This means that the blood vessels carrying blood to different parts of the body will start to swell inside and cause a decrease in the amount of blood that will reach certain organs. This decrease in blood flow can cause the organ to start to malfunction and can quickly cause permanent damage.  Because of the possibility of severe organ damage, it is important to recognize the disease quickly and start treatment as soon as possible.  This is particularly true regarding the eyes, where GCA can cause rapid, severe and permanent loss of vision.

Although GCA can affect both eyes, it usually affects one initially.  Therefore, by diagnosing the condition early and starting treatment immediately, the presenting eye may not sustain significant permanent damage, and the fellow eye may be spared any involvement.

This condition is more commonly seen in people over the age of 50.  It less commonly found in African-Americans.

Symptoms of Giant Cell Arteritis

  • Fever
  • Generalized “ill” feeling
  • Jaw pain that comes and goes or occurs when chewing
  • Loss of appetite
  • Muscle aches
  • Pain and stiffness in the neck, upper arms, shoulder, and hips
  • Throbbing headache on one side of the head or the back of the head
  • Scalp sensitivity, tenderness when touching the scalp
  • Vision difficulties
    • Blurred vision
    • Double vision
    • Reduced vision (blindness in one or both eyes)
  • Weakness and/or excessive tiredness
  • Weight loss (more than 5% of total body weight)

When GCA is suspected, your doctor will order some tests to help in the diagnosis. The most common are a complete blood count, C-reactive protein, and a sedimentation rate. These tests are looking for signs of inflammation in the body. The tests, however, are not specific for the disease as they can be elevated by any cause of increased inflammation in the body. Depending on the severity of your condition and the doctor’s clinical suspicion, treatment may be started before the results of the blood tests are obtained.

Temporal Artery Biopsy

If the results of the blood tests do not confirm the diagnosis, the next step in the workup is to take a biopsy of the temporal artery (in the superficial scalp, just above the ears) and have a pathologist look at the artery under a microscope to help with the diagnosis. If the disease is not confirmed, and there is still a high suspicion, further testing might be needed.

Treatment is with high dose steroids, which is often started by IV administration and then changed to oral. Due to the side effects of steroids it is important that your primary care doctor be informed of your steroid treatment so that your blood pressure and/or diabetes can be monitored.  Treatment can go on for several months, and occasionally, even longer. It is important that you keep all your follow-up appointments and immediately report any changes in your vision because there can be a reoccurrence of the disease once the therapy is stopped.

Jody Abrams, MD 

Neuro-ophthalmologist/Oculoplastic Surgeon

Sarasota Retina Institute

Sarasota, Florida