Temporal (Giant cell) arteritis causes abrupt vision loss in the Aging Eye.
If treated rightaway with high dose steroids vision can be saved.
 Symptoms:
● Scalp pain or tenderness ------------------------------------>
● Jaw claudication (pain when chewing)
● sudden vision loss (transient or partial or complete)
● double vision.
Other symptoms include generalized malaise, weight loss, fever, pain and tenderness of the muscles and joints (polymyalgia rheumatica).
Necrosis of scalp skin may occur.
This is a disease of large and medium sized arteries and affects patients who are over 55 years of age.
It is very important to diagnose this condition as soon as possible. If immediate high dose steroid treatment is not started then about 40% patients will lose
vision in both eyes leading to blindness. It is tragic to go blind in this fashion because immediate steroid treatment will stop the blindness.
In general, as soon as the diagnosis is suspected, high dose corticosteroid (in the range of 80 mg or more
of prednisone) is given. The blood tests requested are: 1) Sedimentation rate (ESR); 2) C-reactive protein (CRP); and 3) Blood counts and hematocrit. The ESR is usually very high and
values more than 100 are not unusual. Several
other blood tests to find some or the other immune disease may also be requested but these do not affect the immediate management decisions. Once the steroid is given, a biopsy
of the temporal artery (in the scalp) is performed to confirm the diagnosis. Since this is a generalized disease, a general medical and rheumatology evaluation will also be performed.
The eye examination clasically reveals an afferent pupillary defect and an altitudnal (horizontal) field of vision defect
(i.e. there is a difference in the clarity between upper and lower half of the objects you see). The color of objects appear desaturated when viewed from the affected eye - so
while from the normal eye you are able to see red color as red, from the affected eye it appears faded or pinkish. The optic nerve or part of it may be swollen (the margins are blurry).
The clinical
signs may vary. Therefore despite whether clinical signs are present or not, if the symptoms are present to warrant suspicion of temporal arteritis, a high loading dose of steroids is given and then
one gains ample time for debate over this diagnosis.
To summarize:
You should not ignore any blurriness of vision if you have a
history of polymyalgia or are having
scalp tenderness or jaw pain while chewing food. For more on giant cell arteritis you can read the full text of the article below - reproduced with permission. (Gurwood
AS, Malloy KA. Giant Cell Arteritis. Clinical and Experimental Optometry 2002:85(1);19-26)
|
